Allaire Rehab & Nursing

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

10:20 A.M., with UM #2 for the floor where Resident #2 resided, she stated that someone was supposed to be with Resident #2, but not as 1:1. Their job was just watch the resident.During an interview with the DON

on 08/06/2025 at 11:15 A.M., she stated that the role of the companion was to go with the resident and keep them safe, to supervise. The DON further stated that while some of the staff consider it 1:1, it was really a companion. The DON stated that Resident #2 liked to go outside for exercises, and to use the vending machines and to attend activities on another floor. The DON stated that she did not feel a companion should be care planned. The DON stated that it was not the type of 1:1 that required a physician's order. The DON did not provide further information for how both Residents #1 and Resident #2 were not protected from physical harm on the day of the incident.NJAC 8:39-4.1(a)(5)

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If continuation sheet

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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Allaire Rehab & Nursing

115 Dutch Lane Road Freehold, NJ 07728

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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

The LNHA acknowledged that an assessment should have been done.On 08/07/2025 at 2:24 P.M., during a follow-up interview with the SW, she stated, Administrator or myself is responsible for initiating an investigation when there is an allegation of abuse. The SW stated that an investigation required obtaining statements from staff, and the nurses wrote the Incident Report because the of the skin integrity and the nurse was responsible for notifying the physician. The SW stated that the facility was technically still investigating and there was no summary or conclusion at that time.On 08/07/2025, at 3:37 P.M., during an

interview with the Director of Nursing (DON), she stated that when notified of an allegation of abuse, the alleged victim and perpetrator must be immediately separated, the investigation begins and then call the police. The DON verified that an investigation should have been started when the police made the facility aware of the allegation of abuse. The DON stated that in her absence, the staff should have known what to do.An acceptable Removal Plan (RP) was received on 08/11/2025 at 10:27 A.M., indicating the action the facility will take to prevent serious harm from occurring or reoccurring. The facility implemented a corrective action plan to remediate the deficient practice including: on 08/05/2025, the LNHA after hearing the allegation from the police officers, interviewed Resident #8 who stated they felt safe and there was no abuse occurring. Resident #8 stated they wanted to continue having RR #1 visit them and it was family drama, and Resident #8 was provided emotional support. On 08/06/2025, the SW interviewed Resident #8, and a skin assessment was attempted but the resident refused. On 08/06/2025 and 08/07/2025, statements were collected from the staff. The staff collected a statement from RR #1, who denied hitting or abusing the resident. The LNHA, SW, and DON were immediately re-educated on the investigative process of alleged abuse. On 08/07/2025, the LNHA and DON revised the facility's abuse policy to clarify that any allegation, regardless of source or resident's perception, triggers an immediate investigation. On 08/07/2025, training on the Investigation of Abuse was started for all staff by the DON.The survey team verified the implementation of the Removal Plan on-site on 08/12/2025 at 12:45 P.M.NJAC8:39-4.1(a)(5)

Event ID:

Facility ID:

If continuation sheet

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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Allaire Rehab & Nursing

115 Dutch Lane Road Freehold, NJ 07728

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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

resident's bedside, and stated she knows she should not have, It is not the policy. She further stated that

she does not normally do that, but the resident's caretaker wanted the medications to be given in pudding so she left the medications to wait for pudding.During an interview with the Director of Nursing (DON) on 08/06/5025 at 4 2:51 P.M., she stated that it was not the policy for nurses to leave medication at bedside.

The expectation would be if they do not take the medication then mark them as refused.Review of the facility policy dated 01/2025 indicated; Administering Medications under the Policy Statement, Medications shall be administered in a safe and timely manner, and as prescribed. Under Policy Interpretation and Implementation, 3. Medications must be administered in accordance with the orders, including any required time frame. 4.Medicaitons must be administered within one (1) hour of their prescribed time, unless otherwise specified. 18. If a drug is withheld, refused or given at a time other than the scheduled time, the individual administering the medication shall indicate such on the MAR.NJAC 8:39-29.2 [d]

Event ID:

Facility ID:

If continuation sheet

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

08/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Allaire Rehab & Nursing

115 Dutch Lane Road Freehold, NJ 07728

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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

supervisor/manager to check Resident #8 every 30-minutes to ensure no threat while the investigation was being concluded. The LNHA received education from the Regional Director of Nursing (RDON) about abuse prevention oversight, reporting, and compliance timelines. The facility's abuse prevention program was reviewed and revised to reflect appropriate reporting timeframes in addition to the requirement of mandatory reporting and proper investigation. The LNHA was additionally educated by the RDON regarding regulatory requirements for F 600 and F 610.The survey team verified the implementation of the Removal Plan on-site on 08/12/2025 at 12:45 P.M. NJAC 8:39-9.2(a)NJAC 8:39-9.3(a)NJAC 8:39-27.1(a)

Event ID:

Facility ID:

If continuation sheet