Careone At The Highlands

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

contamination from the skin into the open wound.) The RN, with the same contaminated gloves, applied Santyl directly on to the gauze pad, placed the gauze onto the wound bed, opened the Calcium Alginate and packed the wound. The RN, with the same contaminated gloves, reached into her pocket, removed a pen, dated the foam dressing and applied it to the wound. The RN did not sanitize the over bed table after

the wound treatment was completed.The RN removed her gloves and, with no observed hand hygiene, brought the unused supplies out of the room and placed them back into the treatment cart. On 10/23/25 at 10:55 AM, in the presence of the Director of Nursing (DON), the surveyor discussed the infection control breaches with the RN, who confirmed that she should have removed her gloves and sanitized her hands

after she removed the soiled dressing and should have performed hand hygiene before leaving the resident's room. The RN acknowledged that she should have cleansed the wound from the inside out to prevent possible bacteria from contaminating the wound bed, should have only brought supplies that would be used for the treatment into the room, should not have placed the unused supplies back into the treatment cart, and should have sanitized the treatment cart after the treatment was completed. The DON confirmed the breaches in infection control. On 10/23/25 at 3:13 PM, the surveyor discussed the above

observations and concerns with the License Nursing Home Administrator and DON. A review of the facility's Dressings, Dry/Clean revised 9/2013 reflected.The purpose of this procedure is to provide guidelines for

the application of dry, clean dressings.Steps in the procedure: Clean bedside stand, establish a clean field Place supplies on a clean field Wash and dry your hands thoroughly Put on clean gloves, remove soiled dressing, pull glove over dressing, and discard Wash and dry hands thoroughly Label the tape or dressing with the date, time, and initials. Place on a clean field. Using clean technique, open other products (prescribed dressing; i.e., dry, clean gauze.) Wash and dry your hands thoroughly Put on clean gloves Clean the wound with the ordered cleanser. If using gauze, use clean gauze for each cleansing stroke, cleanse from the least contaminated area to the most contaminated area (from the center of the wound outward) Remove disposable gloves and discard. Wash and dry your hands thoroughly Clean the bedside stand Wash and dry your hands thoroughly NJAC 8:39-19.4(a)

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Careone at the Highlands

1350 Inman Avenue Edison, NJ 08820

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Resident #1. LPN #1 stated that the Breo Ellipta was never sent by the pharmacy, and the Triamcinolone took a while. LPN #1 added that she thought she called the pharmacy and the physician when the medications were not available. LPN #1 added that she was supposed to document in the progress notes when she spoke with the physician. LPN #1 was unable to speak to what follow up the physician had said to do. LPN #1 stated that there was no back up medications available in the facility and had to wait until the pharmacy sent the medications. LPN #1 acknowledged that there was no documentation in the progress notes that she had contacted the pharmacy. On 10/23/25 at 2:37 PM, the surveyor interviewed the Director of Nursing (DON) who stated that there was back up medications available in the facility but there was no inhalers or steroid creams available. The DON added that if a medication was not available, the nurses should call the physician for follow up orders such as ordering another similar medication that was available or obtaining a PO to hold the medication until the pharmacy was able to deliver the medication. The DON added that the pharmacy needed to be called to verify the medication was being delivered. The DON added that calling the pharmacy and physician should be done the first time a medication was not available and documented in the progress notes as to what was the follow up. The DON explained that when she received a new admission on the 3 PM to 11 PM shift, she would not receive medications until noon or 1 PM the next day so the physician should be aware of that, and a PO would indicate when to start a medication. DON also explained that inhalers were difficult because there was no back up inhalers available, but the physician may order something different, or the nurses could reach out to the family, or a PO would indicate to hold the medication until pharmacy delivered the inhaler. At that time, the surveyor and DON reviewed the EMAR for Resident #1. The DON acknowledged that there should not be continued documentation that a medication was not available and there should have been documentation if the pharmacy and physician were notified. The surveyor reviewed the facility policy with a revision date of 4/2019 for Administering Medications provided by the DON which reflected Medications are administered in

a safe and timely manner, and as prescribed. NJAC 8:39-11.2(b); 29.2(a)(d)

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