River Front Rehabilitation And Healthcare Center

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

allowed was 20 minutes, and she/he was allowed only two cigarettes during each smoke break. Resident R28 stated she/he would like to be able to smoke more than two cigarettes at a time and she/he would like to be able to smoke after dinner and/or before bed. Resident R28 stated there were not offered smoke times after 4:00 PM, and so smoking in the evening/at night was not an option. e. Review of Resident R29's admission Record, dated 09/05/25 and found in the EMR under the Profile tab, revealed the resident was admitted to the facility on [DATE REDACTED].

The resident's diagnoses included osteoarthritis and chronic viral hepatitis. Review of Resident R29's quarterly MDS) assessment with an ARD of 08/08/25 and found in the EMR under the MDS tab, indicated a Brief Interview for Mental Status (BIMS) score of 15 out of 15 which indicated the resident was cognitively intact. Review of Resident R29's Smoking/Nicotine Devices Assessment, dated 12/02/24 and found in the EMR under the Assessment Tab, revealed Resident R29 was a smoker and revealed Resident R28 preferred to smoke in the morning and the afternoon.

During an interview with Resident R29 on 09/02/25 at 4:10 PM, Resident R29 confirmed residents could smoke three times per day for 20 minutes each time and were allowed to have only two cigarettes at each smoke time. Resident R29 stated she/he would like to smoke after dinner, but was not allowed to. Resident R29 further stated she/he did not understand why residents were only allowed to have two of their cigarettes at each smoke break since the cigarettes were the property of each resident. NJAC 8:39-27.1 (a)

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Front Rehabilitation and Healthcare Center

5101 North Park Drive Pennsauken, NJ 08109

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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

covers.During a Group Interview on 09/03/25 at 1:00 PM with eleven alert and oriented residents (Resident (R) 12, Resident R17, Resident R18, Resident R19, Resident R20, Resident R21, Resident R22, Resident R23, Resident R24, Resident R25, and Resident R26), the following verbalizations were made:a. The equipment, including wheelchairs and shower chairs, is dirty.b. Resident bathrooms and walls need to be cleaned.c. Shower room walls and curtains need to be cleaned.d. There are many flies in the facility and ants near the nurses' stations. On 09/05/25 at 9:27 AM, a tour of the facility was conducted with two surveyors, the Maintenance Director (MD), Environmental Director (ED), Regional [NAME] President of Environmental Services, and the Administrator to identify the above concerns to the management staff.

Following the facility tour on 09/05/25 at 10:20 AM, the ED stated, When I came, 10 months ago, there was no system in place to clean rooms, floors, halls, etc. The discoloration on the walls is most likely splatter from spraying bleach. Following the facility tour on 09/05/25 at 10:30 AM, the MD stated, This is my fourth week in the facility, I appreciate the extra eyes. We can get this all fixed in time. Review of the undated Hallway Duty List, provided by the ED, noted areas to be cleaned as well as resident rooms, however no specifics were identified as to what that involved. An undated Curtain Wash Schedule was provided for resident rooms only. An undated Shower Room Cleaning form listed the following to be completed every two to five days: Clean shower bed, clean shower chair, wipe handrails, clean walls, wash shower curtains, check sharps box, pull trash, and scrub floors. Review of the Wheelchair Cleaning Log from 01/25 - 08/25 noted wheelchairs were cleaned every three months. Review of the Maintenance TELS log, provided by the MD, noted facility checks to be completed, none of which was listed above. 2. During an initial tour conducted of the facility on 09/02/25 from 11:00 AM - 11:30 AM, the following concerns were noted related to the facility physical environment: Walls in common areas such as hallways and day areas and in resident rooms on all three floors/units in the facility were scuffed, dirty (with brown stains and light colored streaks).Floors in resident rooms and the common hallways on all three units were extremely sticky and the floors were grimy and dirty in corners and against baseboards throughout the units.Door frames at resident room and common room entries were dirty, stained and peeling on all three floors/units.Door numbers were partially or completely missing for many of the resident and common rooms throughout the facility.Trash a debris was observed on floors throughout all three floors/units, but particularly on the second and third floor units.The was a strong urine odor on the second and third floors/units at the lower number end of each hall.Heating/air conditioning registers in resident rooms and common areas on the second and third floor units were dirty and many were broken. During a group interview with 11 residents, including the Resident Council President and Resident Council [NAME] Present, conducted on 09/02/25 at 1:00 PM, the group reported facility bathrooms (in resident rooms) were nasty (dirty), the facility walls were very dirty and needed to be cleaned, the toilet in the hallway bathroom on the second floor had been broken and unusable for four days, shower rooms throughout the facility were dirty, floors throughout the facility were always sticky, and window screens throughout the facility were broken. During a tour conducted with the Maintenance Director, the Director of Housekeeping and Laundry, the [NAME] President of Environmental Services, and the Administrator on 09/05/25 from 10:30 AM - 11:20 AM, all four staff members confirmed

the above documented environmental concerns. NJAC 8:39 -31.8(10)NJAC 8:39 -31.4(a)(f)

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Front Rehabilitation and Healthcare Center

5101 North Park Drive Pennsauken, NJ 08109

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

06/30/25 11:47 AM and found in the EMR under the Notes Tab, indicated Resident noted with bruising and discoloration to right hand, area cleansed with soap and water and applied an ice pack to area. Full ROM (Range of Motion) to both hands noted with no facial grimacing when touched or using affected hand.

Referred to be seen by wound care. NP (Nurse Practitioner) made aware, Daughter made aware. Review of

the facility's investigation documentation related to Resident R2's bruise of unknown origin revealed the incident was not reported as potential abuse to the State Agency (SA) until 07/01/25 at 11:13 AM (almost 24 hours after

the injury of unknown origin was initially identified). During an interview with the Administrator 09/03/25, she confirmed the above stated injury of unknown origin was not reported to the SA until 07/01/25. During an

interview with the BOM, the [NAME] President of Clinical, the Regional Nurse Consultant, and the Administrator on 09/04/25 at 11:40 AM, the Clinical President of Clinical and the Regional Nurse Consultant confirmed Resident R2's injury of unknown origin was expected to have been reported to the SA within two hours of identifying the injury and confirmed the report submitted to the SA by the facility on 07/01/25 was submitted late. 3. Review of Resident R15's admission Record, dated 09/05/25 and found in the EMR under the Profile tab, revealed the resident was admitted to the facility on [DATE REDACTED]. The resident's diagnoses included schizoaffective disorder and chronic kidney disease. Review of Resident R15's admission MDS assessment with an ARD of 09/04/25 and found in the EMR under the MDS tab, indicated a BIMS score of three out of 15 which indicated the resident was severely cognitively impaired. Review of Resident R15's Progress Notes, dated 09/01/25 at 9:15 PM and found in the EMR under the Notes Tab, indicated This writer was made aware that two resident was arguing. This writer went to investigate and notice (Resident R16) and (Resident R15) facing each other. This writer immediately separated both resident (for) safety. Resident was assessed and found to have no injuries (Resident R15) was brought back to his room and place on 1:1[one to one monitoring]. The resident was also reminded of his room change from 130A to 324B. Family, DON, and MD (Medical Doctor) made aware.

Review of Resident R16's admission Record, dated 09/05/25 and found in the EMR under the Profile tab, revealed

the resident was admitted to the facility on [DATE REDACTED]. The resident's diagnoses included vascular dementia and anoxic brain damage. Review of Resident R16's quarterly MDS assessment with an ARD of 07/11/25 and found

in the EMR under the MDS tab, indicated a BIMS score of five out of 15, which indicated the resident was severely cognitively impaired. Review of Resident R16's Progress Notes, dated 09/01/25 at 9:49 PM and found in the EMR under the Notes Tab, indicated DON made aware by supervisor that resident had a verbal altercation with another resident (Resident R15). Residents immediately separated and patient placed on a 1:1. Review of the facility's investigation documentation related to the above allegation of potential resident to resident verbal abuse revealed the incident was reported to the SA on 09/02/25 at 9:30 AM (almost 12 hours after the incident occurred). During an interview with the Administrator 09/03/25, she confirmed that the above stated resident to resident altercation was not reported to the SA until 09/02/25. During an interview with

the Business Office Manager (BOM), the [NAME] President of Clinical, the Regional Nurse Consultant, and

the Administrator on 09/04/25 at 11:40 AM, the Clinical President of Clinical and the Regional Nurse Consultant confirmed Resident R15 and Resident R16's verbal altercations was expected to have been reported to the SA within two hours of observation of the incident and confirmed the report submitted to the SA by the facility

on 09/02/25 was submitted late. NJAC 8:39-9.4(f)

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Front Rehabilitation and Healthcare Center

5101 North Park Drive Pennsauken, NJ 08109

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

exploitation/financial abuse of Resident R1 by FM1 should have been identified and investigated by the facility prior to 09/04/25 when the surveyors brought the concerns to their attention. 2. Review of Resident R2's admission Record, dated 09/05/25 and found in the EMR under the Profile tab, revealed the resident was admitted to

the facility on [DATE REDACTED]. The resident's diagnoses included dementia, cerebral ischemia and Chronic Obstructive Pulmonary Disease. Review of Resident R2's quarterly MDS assessment with an ARD of 07/18/25 and found in the EMR under the MDS tab, indicated a BIMS score of zero out of 15 which indicated the resident was severely cognitively impaired. Review of Resident R2's Progress Notes, dated 06/29/25 10:00 AM, entered into

the resident's record on 06/30/25 at 3:34 PM, and found in the EMR under the Notes Tab, indicated Aide (Certified Nursing Assistant (CNA6) stated that the resident refused care and out of nowhere the resident started swinging his backscratcher at her. Writer went to resident's room to speak with resident, resident denied that he tried to hit Aide. PT (patient) teaching was giving for refusal of care. Review of Resident R2's Progress Notes, dated 06/30/25 11:47 AM and found in the EMR under the Notes Tab, indicated Resident noted with bruising and discoloration to right hand, area cleansed with soap and water and applied an ice pack to area. Full ROM (Range of Motion) to both hands noted with no facial grimacing when touched or using affected hand . Review of the facility's investigation documentation, dated 6/29/25, related to Resident R2's bruise of unknown origin revealed the incident was not fully investigated per the facility's abuse policy/requirements.

The investigation did not include interviews with staff members present on the day of the event, during which it was reported Resident R2 attempted to strike CNA6 with his/her reacher and CNA6 pulled the reacher from his/her hand to ensure abuse of Resident R1 by CNA6 did not occur during that incident, resulting in the bruising to Resident R1's hand. During an interview with the Administrator 09/03/25, she confirmed interviews had not been conducted with staff present on the day of the event that occurred between CNA6 and Resident R1 to ensure no abuse of Resident R2 by CNA6 had been perpetrated. The Administrator stated that the CNA was suspended.

During an interview with the Business Office Manager (BOM), the [NAME] President of Clinical, the Regional Nurse Consultant, and the Administrator on 09/04/25 at 11:40 AM, the Clinical President of Clinical and the Regional Nurse Consultant confirmed Resident R2's injury of unknown origin was expected to have been thoroughly investigated, including interviews with any staff who was present at the time of/may have had direct knowledge about the events which might have caused the injury to Resident R2. NJAC 8:39-27.1(a)

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Front Rehabilitation and Healthcare Center

5101 North Park Drive Pennsauken, NJ 08109

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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Complaint # 179036Based on record review, interviews, and policy review, the facility failed to develop a comprehensive care plan for one of two residents (Resident (R) 8) sampled for the use of a Life Vest, (a wearable defibrillator). Findings include: Review of the admission Record located under the Profile tab in the electronic medical record (EMR) revealed Resident R8 was initially admitted on [DATE REDACTED] and discharged to home on [DATE REDACTED]. Resident R8 had diagnoses that included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, hypertensive heart disease with heart failure, chronic atrial fibrillation, unspecified, and chronic diastolic (congestive) heart failure. Review of the Physician Orders located under the Orders tab in the EMR revealed Resident R8 received an order for a Life Vest on 09/19/24. The order noted Change life vest battery every day shift. Life vest manufacturer [NAME] 1-8005433267serial # 58020305. Check [NAME] monitor for function and placement. Review of the 09/19/24 Comprehensive Care Plan located under the Care Plan tab in the EMR revealed The resident has altered cardiovascular status r/t (related to) CHF (congestive heart failure), afib (atrial fibrillation) use of life vest. The goal was identified as The resident will be free from complications of cardiac problems through the review date. The interventions listed Assess for shortness of breath and cyanosis every (specify). Encourage low fat, low salt intake. The care plan failed to address the cleanliness of the Life Vest, personal hygiene when utilizing a Life Vest, responding to alarms, and when to notify the resident's physician in the comprehensive care plan for Resident R8 who utilized a Life Vest, a wearable defibrillator. Review of the Treatment Administration Records (TAR) for the months of 09/24, 10/24, 11/24, and 12/24, located under the Orders tab in the EMR, revealed the nursing staff were changing the battery every day and monitoring the [NAME] for function and placement every shift. During

an interview with the Minimum Data Set Coordinator (MDSC) on 09/05/25 at 2:16 PM, the MDSC stated,

We all work on the care plans, but I did not complete (Resident R8's). During an interview with the Director of Nurses (DON) on 09/05/25 at 2:16 PM, the DON stated, I was not employed at that time, I cannot answer. During

an interview on 09/05/25 at 2:30 PM, the Pavilion I Unit Manager (PAV1UM) stated, I do the care plans. I remember (Resident R8). I don't know why (Resident R8's) care plan did not address the specifics of the Life Vest. We changed the battery every day. Review of the Life Vest Policy and Procedure, dated 11/2024, provided by

the Regional Nurse Consultant revealed Nursing home staff must provide safe and competent care for residents utilizing the LifeVest wearable defibrillator. This includes ensuring proper use, monitoring, and maintenance of the device, as well as providing education to staff and residents to prevent complications and ensure effective operation.Daily Care/Device Inspection identified Check the LifeVest daily for proper positioning, cleanliness, and secure fit. Inspect electrode pads and battery connections to ensure the device is functioning. Assist residents in maintaining hygiene without compromising the LifeVest's functionality. When removed for bathing, ensure the device is promptly re-worn as instructed by the manufacturer.Ensure spare, fully charged batteries are available. Replace the battery per the manufacturer's instructions to avoid interruptions in monitoring. Responding to Alarms/Non-Emergency Alarms: If the LifeVest issues a non-emergency alert (e.g., low battery, poor connection), address the issue following the manufacturer's troubleshooting steps. Document any actions taken and notify, the resident's physician if necessary. Emergency Alarms (Shock Delivery): If the LifeVest delivers a shock:l. Monitor the resident's condition immediately. 2. Call 9l1 and notify the physician for further assessment. 3. Record the event in the residents' medical chart, including the time, observed symptoms, and response to the shock.

NJAC 8:39-27.1(a)

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Front Rehabilitation and Healthcare Center

5101 North Park Drive Pennsauken, NJ 08109

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Complaint # : 178254 and 179036 Based on observations, record review, and interviews, the facility failed to ensure the ceiling vents, ice machine vent, and equipment were kept clean and/or in good repair. The failure had the potential to affect 149 of 153 residents who received meals prepared in the facility kitchen.

Findings include:During an inspection of the kitchen on 09/04/25 at 8:45 AM, along with the Dietary Director (DD), the following was observed:a. Three of the insulated food carts were checked for door closure. Two failed to latch and a third cart had no latch on one of the doors.b. The ceiling vent located at

the end of the prep table, next to the oven/stove, had a heavy buildup of a black substance.c. The ceiling vent above the prep table had a heavy buildup of a black substance.d. The vent on the outside of the ice machine had a black substance that came off one. The vent on outside of ice machine had black substance that came off on my finger when touched.f. The tray line table, equipped with rollers to allow the trays to move easily, had missing rollers. The table was observed to have a piece of cardboard taped to the sides of

the table with duct tape. The duct tape was identified to be tattered and rolled on the edges, making it an uncleanable surface.g. The prep table, located behind the plate warmer, was observed with significant rust

on the legs, shelf, and edges of the table.h. A portable stand fan, located next to the oven, was observed blowing on prep table, The fan had no front cover, the blades were exposed, and had a build up of dust and grime. During an interview on 09/04/25 at 8:58 AM, the DD stated, That's a good question, when asked whose responsibility it was to clean the vents. During a tray line observation on 09/04/25 at 12:00 PM, the above conditions were identified to the Regional Food Service Director (RFSD). The RFSD was unable to clarify who was responsible for cleaning the vents, fixing the rollers on the tray table, removing the rust from

the prep tables, cleaning the fan and putting a front on the fan to cover the blades. Review of a cleaning schedule, dated Week of 8/25-8/30, provided by the RFSD and the DD on 09/05/25 at 12:02 PM, revealed there were no cleaning job for the vents, ice machine, or the floor fan. The RFSD said they were going to have the Maintenance Director (MD) fix the latches on the insulated food carts. There was no evidence that

the insulated food carts had been identified to require repairs prior to 09/05/25. A Policy and Procedure for kitchen cleaning was not provided prior to the exit on 09/05/25 at 3:30 PM. NJAC 8:39-17.2(g)

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

River Front Rehabilitation and Healthcare Center

5101 North Park Drive Pennsauken, NJ 08109

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 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Complaint # : 185875 Based on record review, observations, staff interviews, and review of facility policy, the facility failed to ensure an effective pest control program within the facility. Flies were observed in multiple areas of the building during the complaint investigation process. This failure created the potential for cross contamination related to the fly infestation. A total of 34 residents were reviewed in the sample. Findings include:Review of the facility's Pest Control Policy dated 11/2024 revealed, Our facility shall maintain an effective pest control program. 1. This facility maintains an ongoing pest control program to ensure that the building is kept free of insects and rodents. Review of the facility's pest control logs, dated 06/01/25 through 09/05/25, revealed multiple entries indicating flies and/or cockroaches/water bugs had been reported on all three of the facility units during that time period. During the initial tour of the facility on 09/02/25 from 11:00 AM - 11:30 AM, at least 15 flies were observed flying about on the third floor unit, a very large dead roach was observed laying upside down in the entry to room [ROOM NUMBER] on the second floor unit, at least 10 flies were observed flying about on the second floor unit, and four flies were observed flying about on

the first floor unit.During a tour of the facility on 09/03/25 from 10:10 AM - 10:45 AM, two flies were observed flying about and around the non-interviewable resident in room [ROOM NUMBER]-B.During a tour of the facility with the Maintenance Director (MD), the Director of Housekeeping and Laundry, the [NAME] President of Environmental Services and the Administrator on 09/05/25 from 10:30 AM - 11:20 AM, multiple flies were observed flying about on all three floors of the facility.During the group interview conducted with 11 residents, including the Resident Council President and Resident Council [NAME] President, on 09/03/25 at 1:00 PM, the group unanimously indicated flies were an ongoing problem in the building and the residents stated they also frequently saw large black water bugs in the facility in common areas as well as their individual rooms. One resident stated she/he had just seen a large black water bug in his room the previous night. Three residents confirmed they had seen flies in the building on the day of the interview. The residents further indicated ants were sometimes a problem on the second floor unit around

the nurse's desk. All of the residents confirmed the pests were bothersome to them.During an interview with Certified Nursing Assistants (CNA)3 and CNA4 on 09/03/25 at 4:45 PM, both confirmed they had recently seen ants around the second floor nurse's desk. During an interview with the Director of Housekeeping and Laundry and the [NAME] President of Environmental Services on 09/05/25 at 1:33 PM, both confirmed the observation of multiple flies on all three units of the facility during the tour conducted on 09/05/25. The Director of Housekeeping and Laundry confirmed he had received recent reports of flies in

the facility and stated he was aware of sightings of water bugs in the facility. He stated all facility staff was expected to document sightings of pests in the pest control books kept on each unit and he stated the pest control company was in the facility every Friday. He stated the pest control company provided pest control based on reports of pests received during the week prior to each visit.During an interview with the Administrator on 09/05/05 at 2:00 PM, she stated her expectation was the facility should be free of pests.

N.J.A.C. S 8:39-31.5

Residents Affected - Some

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

Event ID:

Facility ID:

If continuation sheet