Livia Health And Senior Living

According to the facility's New Jersey Universal Transfer Form (NJUTF) dated 02/10/25 with Time of Transfer: 11 pm [11:00 PM] and Reasons for Transfer: Resident [came] back from (hemodialysis) H.D.

Hypothermia (low body temperature) exposed to the cold x 5 hours [for 5 hours].

A review of the facility's Summary of Investigation (SOI) under Description: On Monday, 2/10/25 at approximately 2227 [10:27 pm], [Resident #1's name] was observed lying on the floor in the transport van.

She/he was picked up by [van driver's name] from [dialysis center name] and was transported back to [facility's name] parking lot at 1700 [5:00 pm].

The SOI provided the following timeline:

- 1009 [10:09 am] Transfer log indicates [the] time Resident #1 [name] left the facility.

- 2148 [9:48 pm], the nurse assigned [name], Licensed Practical Nurse (LPN) #1, reached out to the nursing supervisor to inquire about the Resident's return.

- 2149 [9:49 pm], [the] nursing supervisor called the dialysis center x 3 [ three times] and the main center x 3, but there was no answer. A building search was initiated, and the transfer log was checked.

- 2202 [10:02 pm], the nursing supervisor called the Resident's [family member]. [The] building search continued.

- 2204 [10:04 pm], the nursing supervisor called the van driver [name] to confirm the Resident [name] returned to [the] facility.

Search continued.

- 2221[10:21 pm], the nursing supervisor exited the front of the building to check the van.

315529

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 315529 B.

Wing 02/26/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Livia Health and Senior Living 1 South Ridgedale Avenue East Hanover, NJ 07936