Belle Care Nursing And Rehabilitation Center
BELLE CARE NURSING AND REHABILITATION CENTER in TRENTON, NJ — inspection on June 26, 2024.
Found 38 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
jeopardy to resident health or reflected a brief interview for mental status (BIMS) score of 12 out of 15, which indicated a safety moderately impaired cognition.
resident room should have been cleaned in a timely fashion and that residents should have the expectation to receive quality care and quality living environments.
On 6/26/24 at 10:35 AM, the Licensed Nursing Home Administrator (LNHA), in the presence of the Regional Nurse and Assistant Director of Nursing (ADON), and DON, acknowledged that the facility was aware of ongoing issue with Resident #60's room, but have never approached the resident to discuss whether or not this living condition impacted them.
A review of the facility's Resident Rights policy, created 2/2024, included .The resident has a right to a safe, clean, comfortable and Homelike Environment, including but not limited to receiving treatment and supports for daily living safely .
A review of the facility's undated Quality of Life- Homelike Environment policy included .2.
The facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting.
These characteristics include: a.
Cleanliness and order .e.
Pleasant, neutral scents .
A review of the facility's undated Certified Nurse Aide Position document included .22.
Ensures that residents and families receive the highest quality of service in a caring and compassionate atmosphere which recognizes the individuals' needs and right .
A review of the facility's undated Licensed Practical Nurse Position document included .9.
Supervises and coordinates nursing personnel in providing direct resident care in adherence with state and federal regulations. 10.
Ensures that residents and families receive the highest quality of service in a caring and compassionate atmosphere which recognizes the individuals' needs and right .
A review of the facility's undated Registered Nurse Position document included .2. 9.
Supervises and coordinates nursing personnel in providing direct resident care in adherence with state and federal regulations.
NJAC 8:39-4.1 (a), 11
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The survey team verified the implementation of the Removal Plan during the continuation of the on-site survey on 8/30/24.
NJAC 8:39-4.1(a)12
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The surveyor requested a copy of the resident's admission agreement safety and resident rights.
the following: A review of the Inmate Resident Dining policy dated 8/21/23, included it is the policy of the [facility] to provide meals and snacks in a manner that supports establish security protocols.
Procedure: 1. all inmates will receive their meals and snacks and dine in their room; 2. all inmate resident meals will be served on disposable paper goods; 3. all inmate resident meals will be served with plastic utensils; metal utensils are never permitted; 4. prior to delivery of meal tray to the inmate resident the CO in attendance will be offered the opportunity to check the tray .7. there is no food or drinks other than a water pitcher (when clinically approved) be stored at bedside .
A review of the Inmate Phone Use policy dated 8/21/23, included 1. inmates are not routinely permitted to access telephones, not landlines or cell phones; 2. the landline will be removed from the inmate room prior to admission; 3. the staff is not to facilitate or participate in allowing inmates to use a telephone; 4. in rare circumstances when telephone use is permitted this will be entirely taken care of by the [CF staff], specifically the assigned COs; 5. at no time is [facility] staff to participate in inmate's phone use.
A review of the Concerns with Correctional Officers policy dated 9/12/23, included that COs should be treated with dignity and respect by all staff .
On 8/29/24 at 3:05 PM, the DON informed the survey team that she had spoken to the CF to have the CF inform the facility who was permitted to visit the resident and when.
An acceptable Removal Plan (RP) on 8/30/24 at 1:44 PM indicated 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 the resident was returned to the CF on 8/29/24; the facility ended their contract with the CF to accept JIR and has no other contracts with additional CFs to accept JIRs; the LNHA and DON were inserviced regarding CMS's S & C memo regarding JIR; and the LNHA was responsible for the implementation of all facility policies and regulations.
The survey team verified the implementation of the Removal Plan during the continuation of the on-site survey on 8/30/24.
NJAC 8:39-4.1(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
responsible for monitoring and ensuring the ABN's are completed on each resident in a timely manner
make an informed decision about whether to get services and accept financial responsibility for those
when the notice is [ .] provided far enough in advance of potentially non-covered items or services to allow sufficient time for the beneficiary to consider available options (at least two days) .The beneficiary or the beneficiary's representative must sign and retain the ABN and send a copy of the signed ABN to you for retention in the beneficiary's record.
Keep a copy of the unsigned ABN on file while awaiting receipt of the signed ABN. If the beneficiary fails to return a signed copy, document the initial contact and subsequent attempts to obtain a signature in appropriate records or on the ABN.
NJAC 8:39-5.4 (b)(c)
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
Review of the facility's Cleaning and disinfecting wheelchairs, gerichairs, bedside commode, and privacy curtain policy dated last reviewed March 2024, included ensure that privacy curtains are kept clean and in good repair by: Conduct daily review of all privacy curtains to identify if any.
Soiling is noted.
Remove and replace monthly/as need for cleaning service .
A review of the facility's Resident Rights policy, created February 2024, included .The resident has a right to a safe, clean, comfortable and Homelike Environment, including but not limited to receiving treatment and supports for daily living safely .
A review of the facility's undated Quality of Life- Homelike Environment policy included .2.
The facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting.
NJAC 8:39-31.4(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
on-site survey on 8/30/24.
jeopardy to resident health or NJAC 8:39-4.1(a)(5)(6) safety
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The survey team verified the implementation of the Removal Plan during the continuation of the on-site survey on 8/30/24.
NJAC 8:39-4.1(a)(5)(6)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
checks on employees prior to employment; b.) to complete reference checks on employees before
deficient practice was identified for 2 of 10 employees reviewed for new hires (Employee #9 and Employee #10), and was evidenced by the following: A review of facility's undated Abuse Policy included in the section titled Screening Components that it is the policy of this facility to screen employees and volunteers prior to working with residents.
Screening components include verification of references, certification and verification of license and criminal background check .Employee Screening and Training a.
Before new employees are permitted to work with residents, references provided by the prospective employee will be verified as well as appropriate board registrations and certifications regarding the prospective employee's background .d.
Criminal background check will be conducted on all prospective employees as provided by the facility's policy in criminal background check .
On 6/20/24 at 12:47 PM, the surveyor requested from the Licensed Nursing Home Administrator (LNHA) ten employee files hired since last standard survey who were currently employed or terminated from the facility.
The files include both their personnel and medical.
A review of employee personnel files revealed the following: For Employee #9, a registered nurse with a start date of 2/2/23, there was no evidence of a reference check prior to the start of employment.
For Employee #10, an administrator with a start date of 1/30/23, there was no evidence of a license check, reference check, or criminal background check prior to the start of employment.
On 6/25/24 at 12:57 PM, the surveyor interviewed the Human Resources Director (HRD) about the facility's screening process for new hires, and the HRD stated the facility completed criminal background checks prior to their first day of employment to ensure no one had a criminal history to put our residents at risk for harm.
The HRD stated the facility also completed reference and license checks prior to the first day of employment.
On 6/26/24 at 10:35 AM, the LNHA in the presence of the Director of Nursing (DON), Assistant Director of Nursing (ADON), and survey team acknowledged the missing pre-employment checks.
The LNHA who confirmed every employee should have a criminal background and reference check prior to employment.
NJAC 8:39-4.1(a)(5); 9.3(b)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
administer oxygen at 3 lpm via nasal cannula as needed for shortness of breath if oxygen saturation
On 6/20/24 at 12:16 PM, the surveyor interviewed the MDS Coordinator via the phone who
coded for intermittent oxygen.
The MDS Coordinator added that the facility had changed computer systems and that there were inaccuracies in the transfer.
On 6/20/24 at 9:30 AM, the survey team met with the LNHA and DON who both acknowledged that the MDS for Resident #80 was inaccurate.
A review of facility provided policy Completion of MDS reviewed 04-2023 indicated that: The RN MDS Coordinator is responsible for ensuring the completion of the MDS.
This policy also indicated that Section O is to be completed by Nursing/Therapy Dept.
A review of facility's Resident Assessment Instrument (RAI) Process policy dated reviewed April 2023, included the Clinical Reimbursement Manager will oversee that the Interdisciplinary Team will complete an assessment of each resident as part of the Resident Assessment Instrument (RAI) process to assure data accuracy for the State-specific version of the Minimum Data Set (MDS) within the required timeframes according to applicable laws and regulations .
NJAC 8:39-11.2(e)1; 27.1(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The surveyor reviewed the medical record for Resident #73.
A review of the Order Summary Report revealed that Resident #73 was admitted to the facility with diagnosis that included, but not limited to diabetes mellitus, mood disorder, and hypertension (high blood pressure).
The ICCP did not include a focus area identifying the resident's history as being a sex offender.
On 6/25/24 at 1:30 PM, the DON, in the presence of the Licensed Nursing Home Administrator (LNHA), Regional Nurse, Assistant Director of Nursing (ADON), and survey team acknowledged that Resident #73's ICCP should have identified them as a registered sex offender.
A review of the facility's undated Care Plan policy included that all residents admitted to the facility will have adequate person centered care plans that provide for all their needs in a timely manner .Procedure [ .] 2.
They will include initial goals, [physician's orders] orders, medications, treatments, dietary orders, therapy orders, social services, and PASARR recommendations .11.
Care plans will be updated timely and necessary revisions will be made .
NJAC 8:39-31.2(e)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
#60's AFO should have been discontinued in the system and that the nurses were identifying the AFO
The facility could not provide any policy regarding discontinuation of physician's orders and/or accuracy of completing the treatment administration orders.
NJAC 8:39-11.2(b); 27.1(a)
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
CF inform the facility who was permitted to visit the resident and when.
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
Review of the facility's Wound Prevention and Treatment policy dated reviewed March 2024, included Pressure Ulcer Prevention .Provide a pressure reduction surface for bed and/ or wheelchair per the facility's Support Surface Selection Algorithm. (Refer to Algorithm of this Wound Prevention and Management Protocol) .Stage II Treatment .Notify physician and obtain orders for the most appropriate treatment protocol .
NJAC 8:39-27.1(e)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
Formula, Rate and Continuous bolus. 17.
Document total intake separated into formula and water flush
to: Tube placement verification, Time tube feeding initiated, Resident/patient tolerance, and Amount of gastric residual, as applicable .
NJAC 8:39-27.1(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
minimize or prevent the spread of infections .
is the policy of this facility to provide sufficient staff with appropriate competencies and skill sets to
psychosocial well-being of each resident.
The facility's census, acuity and diagnoses of the resident population will be considered based on the facility assessment .the facility will supply sufficient numbers of each of the following personnel types on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans .
NJAC 8:39-25.2 (a); 27.1(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
medications .when CDS medication is administered, in addition to proper procedure for charting of
all CDs medications stored on each nursing unit shall be performed at each change of each shift by
inventory count form .
NJAC 8:39-11.2(b), 29.2 (a)(d), 29.4(k), 29.7(c)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
body) and hemiparesis (weakness of one entire side of the body) affecting right dominant side, Type 1
On 6/20/24 at 9:00 AM, the DON provided the surveyor with Resident #61's CP recommendation reports for May 2024.
The CP recommendation dated 5/27/24, requested to clarify Keppra (a seizure medication) by mouth every 12 hours and give at 9 AM and 9 PM.
This request was acknowledged with a handwritten done, but upon review of the MAR (prior to surveyor inquiry) the order was not clarified until 6/20/24, when the administration times were adjusted per CP recommendation.
The CP recommendation dated 5/27/24, requested to clarify the diagnosis for acetaminophen prn for pain not fever.
This request was acknowledged with a handwritten done, but upon review of the MAR (prior to surveyor inquiry) it was not updated and continued to have the fever diagnosis.
The CP recommendation dated 5/27/24, requested to do an order correction that allowed for blood sugar to be documented on the MAR.
This request was acknowledged with a handwritten done, but upon review of the MAR (prior to surveyor inquiry) there was no space identified to allow documentation of the resident's blood sugar level.
On 6/20/24 at 9:36 AM, the surveyor interviewed the DON who stated that the CP reports were sent to the facility through email by the CP, and the CP's recommendations were to be completed by the unit managers.
The DON stated that an appropriate time for the CP's recommendations to be completed was within seven days of receiving.
The DON could not explain why the recommendations provided from the CP from March 2024, April 2024 and May 2024 were not completed until 6/19/24 after surveyor inquiry.
On 6/20/24 at 12:24 PM, the surveyor interviewed the facility's CP who stated that she had been at the facility since March 2024, and it was important that the facility acted upon the pharmacy recommendations as soon as possible (ASAP) so that if there was a medication safety concern, it could be taking care of immediately.
The CP stated that the facility needed more education because the new pharmacy consultant company was new to the facility and the staff was on a learning curve.
NJAC 8:39-29.3 (b)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
that resident's behaviors are documented in the progress notes.
The DON stated that targeted behaviors would have to be reviewed in the progress notes and how many times a resident experienced a targeted behavior.
She stated that there should be a monthly psychotropic summary sheet (PSS) and indicated that it would be documented in the progress notes.
The DON stated that as the behaviors were occurring then the behavior should be documented in the progress notes.
She added that side effects from medications should also be documented in the progress notes.
On 06/20/24 at 11:24 AM, the DON could not provide the surveyor with PSS or documentation that the psychotropic drugs summaries were being documented monthly.
On 06/24/2024 at 11:39 AM, the facility could not provide any additional information.
The facility policy titled, Medication Use dated 09/2017 indicated that behavior monitoring for all residents on antipsychotic, antianxiety, antidepressant hypnotic medications will be incorporated with the MAR monthly.
The nurse must monitor their subsequent effects on the resident every shift.
Specific behaviors to be monitored will be identified for residents on antianxiety and antipsychotic medications.
The policy also indicated that monthly psychotropic summaries would be completed monthly describing resident progress or deterioration, including summary of psychotropic medications being used and their subsequent effects to the resident/patient.
The summary would include psychiatrist/psychologist visits and any plan for reduction and/or continuation of the medications.
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
bipolar disorder.
Give with 125 MG for a total dose of 625 MG.
The MAR reflected all June dates with
On 6/18/24 at 12:23 PM, the surveyor interviewed UM/LPN #2 regarding the dose of Depakote that was to be administered at 9 AM to Resident #5. UM/LPN #2 checked the electronic records for Resident #5 and stated that the facility had changed electronic charting systems recently and was checking both systems. UM/LPN #2 then verified that the dose of Depakote that Resident #5 was to receive at 9 AM was a total of 625 MG. UM/LPN #2 explained that there was a PO for Depakote 125 MG and Depakote 500 MG to be administered together for a total dose of 625 MG. UM/LPN #2 then reviewed the current MAR and stated that the Depakote 500 MG order was entered incorrectly because the PO had a start date of 6/30/24, and should have been started on 6/11/24, with the Depakote 125 MG PO. UM/LPN #2 added that the Depakote 125 MG PO had instructions regarding the total dose but that when the electronic system started on 6/11/24, the Depakote 500 MG dose would not be highlighted for administration at 9 AM until 6/30/24. UM/LPN #2 was unable to speak to how the PO was entered incorrectly. (ERROR #3) A review of the previous computer system Physician's Orders revealed a PO dated 9/13/22, for Depakote 125 MG tablet, delayed release; give 1 tablet (125 MG) by oral route 2 times per day.
Take with 500 MG for a total of 625 MG. In addition, a PO dated 9/13/22, for Depakote 500 MG tablet; give 1 tablet (125 MG) by oral route 2 times per day.
Take with 500 MG for a total of 625 MG.
A review of the previous computer system MAR reflected the administration of Depakote 125 MG and Depakote 500 MG together at 9 AM for a total dose of 625 MG.
On 6/19/24 at 8:30 AM, the surveyor interviewed the DON who stated that the facility had changed computer systems on 6/11/24, and that all PO were transferred to the new computer system.
On 6/20/24 at 10:45 AM, the survey team met with the DON who acknowledged that there was an error in the dosage of Depakote for Resident #5 that occurred on 6/18/24.
The DON added that she was continuing to investigate how the entry error occurred.
The DON also stated that there were no medication administration observations performed on RN #2 and there were no recent medication administration inservices completed.
A review of the facility's Medication Administration policy dated 12/23/23, included .Verify each medication preparation that the medication is the RIGHT DRUG, at the RIGHT DOSE, the RIGHT ROUTE, at the RIGHT RATE, at the RIGHT TIME, for the RIGHT CUSTOMER .Verify that the MAR reflects the most recent medication order .Medications are administered in a timely fashion as specified by policy .
NJAC 8:39-11.2(b), 29.2(d)
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
seventy-five snacks made throughout the day.
The FSD continued that some snacks were labeled
and milk as snacks.
The FSD provided the surveyor with a list of residents who received snacks
A review of the list provided by the FSD revealed that Resident #3 and Resident #13 had a physician's ordered snack.
On 6/20/24 at 1:24 PM, the surveyor in the presence of the Licensed Nursing Home Administrator (LNHA), DON, and survey team informed the facility of the identified concern, and asked what was considered a nourishing snack.
The DON stated the facility provided peanut butter and jelly sandwiches or applesauce, but the LNHA could not speak to it.
On 6/25/24 at 11:40 AM, the surveyor interviewed the Registered Dietitian (RD) who stated residents received HS snacks upon request or by physician order.
The RD stated there was no formal policy regarding snacks, but not everyone received one, and he was unsure about the regulation regarding the time in between dinner and breakfast.
When asked what a nourishing snack was considered, the RD stated eight ounces of milk, whole sandwich, or pudding.
A review of facility provided Snack Program Policy dated revised October 2022, included .All residents are offered snacks upon admissions and continuously throughout their stay .HS (Hour of Sleep):1.
Dietary Service employees prepare, label, and date snacks including the use by date, according to the menu and in sufficient quantity to serve all residents; 2.
Dietary Service delivers snacks to nursing units/stations at specified times; 3.
Nursing or designated staff offers snack to each resident;4.
Snacks are passed within 15 minutes of delivery to the unit or are properly stored at the nursing station and offered at a later time .
NJAC 8:39-17.2 (f)(1)(i-ii)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
serve food in accordance with professional standards.
food-contact surface cutting board in a manner to prevent microbial growth; and b.) maintain storage
On 6/19/24 at 9:15 AM, the surveyor conducted a kitchen tour with the Regional District Operations (RDO) and observed the following:
- In the walk-in freezer, the vinyl strip curtains located in the entrance to the freezer, there were only
two curtain strips.
These curtains protect the inside of the freezer from outside dust particles as well as keep the cold air from escaping the freezer when the door was opened.
There was also ice accumulation around the door frame.
The RDO acknowledged the freezer needed vinyl curtains and there should not be ice around the door frame.
The RDO stated the vinyl curtains maintained the freezer temperature and the ice was a result of the temperature changing in the freezer.
- At 9:30 AM, the Food Service Director (FSD) joined the tour, and they observed several large
multi-colored cutting boards on the storage rack that were pitted and discolored.
The FSD acknowledged the cutting boards needed to be changed.
- Around the preparation sink on the metal work surface, a pinkish colored liquid.
The [NAME] stated he discarded the juice from the bag of chicken he was preparing in the sink, and the juice must have gotten on the surface.
The FSD and [NAME] both acknowledged the chicken juice needed to be cleaned up and sanitized immediately.
On 6/26/24 at 10:34 AM, the Licensed Nursing Home Administrator (LNHA) in the presence of the Director of Nursing (DON), Assistant Director of Nursing (ADON), and survey team acknowledged these findings.
A review of the facility's Cutting Board Care and Use Policy dated revised October 2023, included once cutting boards develop hard to clean grooves or are excessively worn, they will be replaced.
A review of the facility's Maintaining and Cleaning Equipment policy dated revised March 2024, included the Director of Dining Services or designee will ensure all equipment is maintained, kept clean, and in sanitary condition before and after each use .
NJAC 8:39-17.2(g)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The survey team informed the facility that there were repeated concerns from the last standard survey which included MDS assessments, medication storage, acting on CP reports, antibiotic stewardship program, facility assessment, and QAPI, and asked what the facility implemented to ensure sustainability.
The LNHA acknowledged that even though she started at the facility in April 2024, she was present for the April quarterly QAPI meeting as well as reviewed and signed the facility assessment and reviewed the CMS 2567 from last standard survey. At that time the DON stated she was aware of the facility's previous deficiencies and that facility educated staff and completed reports.
NJAC 8:39-9.2(a); 9.3(a); 27.1(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
Based on observations, interview, and review of pertinent facility documents, it was determined that
procedures necessary to protect the health, safety, and welfare of all residents prior to admission of registered sex offenders and residents admitted from the correctional facility.
This deficient practice was previously identified and cited during the facility's last standard survey on 10/20/22, and was evidenced by the following: Refer F-F865 During entrance conference on 6/17/24 at 10:00 AM, the surveyor requested from the Licensed Nursing Home Administrator (LNHA) and the Director of Nursing (DON) a copy of the facility's assessment.
During initial tour on 6/17/24 at 10:29 AM, the surveyor observed Resident #26 observed in bed asleep.
The surveyor observed that both the resident and their unsampled roommate were both incarcerated with four Corrections Officers (CO) present in the room.
On 6/24/24 at 1:03 PM, the surveyor asked the LNHA and Maintenance Director if the facility had any special populations, and the LNHA confirmed the facility had registered sex offenders and inmates from the [Local] County Jail.
A review of the facility provided Facility Staffing & Resource Assessment Completion Based indicated persons completing assessment included the LNHA, DON, and Medical Director updated 9/17/23 and reviewed with the Quality Assurance and Performance Improvement (QAPI) committee on 4/30/24, did not include registered sex offenders or incarcerated residents as part of the facility's population.
On 6/26/24 at 10:36 AM, the LNHA in the presence of the DON, Assistant Director of Nursing (ADON), and survey team acknowledged the registered sex offenders and inmates were not included in the facility assessment.
During an interview regarding the facility's QAPI program on 6/26/24 at 11:52 AM, the LNHA acknowledged the facility was previously cited for this during the facility's last annual survey.
On 6/26/24 at 12:00 PM, the LNHA informed the survey team that the facility did not have a main contract with the prison, but the facility had individual contracts for the two residents who were inmates currently residing at the facility.
NJAC 8:39-5.1(a)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
acknowledged that even though she started at the facility in April 2024, she was present for the April
deficiencies and that facility educated staff and completed reports.
No additional information was provided.
A review of the facility provided Administrator job descriptions included the Administrator is responsible for planning and is accountable for all activities and departments at [name redacted] subject to rules and regulations promulgated by government agencies to ensure proper health care services to residents.
The Administrator administers, directs, and coordinates all activities of the facility to assure that the highest degree of care is constantly provided to the residents .
A review of the facility provided Senior Director of Nursing Services job descriptions included in addition to the standard responsibilities of Director of Nursing, Senior Director of Nursing is responsible for providing leadership, training and expert guidance.
Individuals selected for this position and must be knowledgeable in all aspects of long term care nursing and have demonstrated ability in managing a nursing department .Performs Related Duties: 1. in the absence of the Administrator and/or licensed Assistant Administrator, the DON is responsible carrying out the administrative duties of the nursing facility .
NJAC 8:39-33.1(a)(e); 33.2 (a)(b)(c)(d)
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
ADON who reviewed, summarized, and completed the monthly report, and the ADON in-services staff
On 6/20/24 at 12:36 PM, the ADON provided the surveyor with a copy of the facility's Monthly
In January 2024, four residents received antibiotics, and three residents had a blank for the diagnostic section (X-ray and laboratory).
In February 2024, six residents received antibiotics, and all six had a blank for the diagnostic section. Resident #40 had no documented symptoms.
In March 2024, six residents received antibiotics, and all six had a blank for the diagnostic section. Resident #44 and Resident #98 both were not indicated if they met the criteria for an antibiotic.
For April 2024, four residents received antibiotics with no residents having documented symptoms; two had diagnostic test documented; none had the origin documented; and no one had documented if the criteria was met.
For May 2024, eleven residents received antibiotics with only two residents had documented symptoms; no one had diagnostic tests documented; none had the origin documented; and no one had documented if the criteria was met.
For June 2024, eight residents received antibiotics with Resident #197 with no documented symptoms; and no one had documented diagnostic testing, origin, or criteria met.
On 6/20/24 at 12:36 PM, the surveyor interviewed the ADON who stated the facility had no IP since April of 2024, everyone was pitching in with infection control.
When asked why the summaries were not completed, the ADON stated she had just completed May's antibiotic stewardship review yesterday.
On 6/20/24 at 12:57 PM, the surveyor informed the LNHA and DON about the missing documentation for the antibiotic stewardship.
The DON stated there was a log on the medication cart with the antibiotic that was being tracked.
No additional information was provided.
NJAC 8:39-19.1
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Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
During entrance conference on 6/17/24 at 10:00 AM, the surveyor asked the Licensed Nursing Home Administrator (LNHA) and Director of Nursing (DON) who the facility's Infection Preventionist (IP) was, and the DON stated the facility's previous IP left about two or three months ago and the position was vacant.
The DON stated herself, the Assistant Director of Nursing (ADON), and the two unit managers reviewed immunizations, antibiotic stewardship, and infection control issues. At that time the surveyor requested a copy of the infection control certifications as well as the date the IP stopped working.
On 6/18/24 at 11:42 AM, the surveyor requested from the LNHA a copy of the infection control certifications and the last date the IP worked.
On 6/19/24 at 12:55 PM, the surveyor requested from the LNHA a copy of the infection control certifications and the last date the IP worked.
On 6/19/24 at 1:36 PM, the surveyor interviewed the DON who stated she did not have a certification in infection control; but she reviewed infection control with the Assistant Director of Nursing (ADON) who also was not certified.
The DON stated only the Unit Manager/Licensed Practical Nurse (UM/LPN) had an infection control certification.
The DON stated the unit managers provided the antibiotic stewardship information to the ADON who reviewed, summarized, and completed the monthly report, and the ADON in-serviced staff on infection control.
On 6/20/24 at 12:36 PM, the surveyor interviewed the ADON who stated the facility had no IP since April of 2024, everyone was pitching in with infection control.
The ADON stated she had just completed May's antibiotic stewardship review yesterday.
On 6/25/24 at 10:58 AM, the surveyor re-interviewed the ADON who confirmed she had no infection control certification, and she was responsible for providing staff with infection control training.
On 6/25/24 at 1:30 PM, the surveyor informed the LNHA and DON of the concern with infection control.
The LNHA stated the previous IP's last day of work was 5/3/24.
No additional information was provided.
A review of the facility's undated Infection Prevention and Control Program policy included the infection prevention and control program is coordinated and overseen by an infection prevention specialist (infection preventionist).
The qualifications and job responsibilities of the Infection Preventionist are outlined in the Infection Preventionist Job Description .
NJAC 8:39-19.1(b)
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
pneumococcal vaccine was not up to date; that the resident was offered and declined.
but the resident was administered influenza vaccine on 9/22/23.
A review of Resident #76's Progress Notes did not include documentation that the resident was educated, offered, and declined the pneumococcal vaccine.
On 6/20/24, the surveyor requested the Pneumococcal Immunization Informed Consent declination form from the DON.
On 6/24/24, a review of a Pneumococcal Immunization Informed Consent, revealed that Resident #76 was offered the pneumonia vaccine on 6/23/24, and declined.
There was no documentation that the resident was educated or that the resident was offered the pneumococcal vaccine prior to surveyor inquiry.
On 6/24/24 at 10:02 AM, the surveyor interviewed the ADON who stated upon admission, the nurse reviewed the resident's vaccination status.
The ADON stated if there was no documented immunizations received, the nurse offered the immunization and had the resident signed the consent form or declined the immunization on the same form.
The ADON stated the resident was offered the pneumococcal vaccine on 6/23/24, but declined.
The ADON confirmed the facility did not have the resident's declination form from admission.
On 6/26/24 at 10:35 AM, the DON in the presence of the LNHA, ADON, and survey team stated, the resident was offered on admissions, but the facility could not provide documentation.
A review of the facility's undated Pneumococcal Vaccine policy included all residents will be offered pneumococcal vaccines to aide in preventing pneumonia/pneumococcal infections.
Prior to admissions residents will be assessed for eligibility to receive pneumococcal series, and when indicated, will be offered the vaccine series within thirty days of admission .before receiving the pneumococcal vaccine, the resident or legal representative shall receive information and education regarding the benefits and potential side effects of the pneumococcal vaccines[ .]provisions of such education shall be documented in the resident's medical record .residents/representatives have the right to refuse vaccination. If refused, appropriate entries will be documented in each resident's medical record indicating the date of refusal of the pneumococcal vaccination .
NJAC 8:39-19.4(i)
315124 06/26/2024
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
Based on observation, interview, and review of other facility documentation it was determined that the facility failed to maintain resident environment, equipment, and living areas in a safe, sanitary, and homelike manner.
This deficient practice was identified for 2 of 2 nursing units (First and Second Floor) and was evidenced by the following: On 6/19/24 at 9:09 AM, the surveyor observed in the hallway by Resident room [ROOM NUMBER] a wheelchair with brown matter that resembled fecal matter, smeared across the seat cushion and down the leg of the wheelchair onto the wheels.
On 6/20/24 at 10:52 AM, the surveyor observed on the Second Floor nursing unit a strong urine odor while approaching Resident room [ROOM NUMBER].
The surveyor entered the room to discover the floor by Bed B was wet and sticky. In addition, puddles of wetness was observed on the bed.
On 6/20/24 at 11:41 AM, the surveyor requested that Registered Nurse (RN #1) walk with them to Resident room [ROOM NUMBER].
While approaching the room, RN #1 acknowledged the strong urine odor, and confirmed that they were aware of the room's condition.
On 6/20/24 at 11:55 AM, the Unit Manager/Licensed Practical Nurse (UM/LPN #1) confirmed the strong smell of urine and acknowledged that Resident room [ROOM NUMBER] should not be in that condition.
On 6/25/24 at 9:43 AM, the surveyor interviewed the Director of Nursing (DON) who acknowledged that Resident room [ROOM NUMBER] should have been cleaned in a timely fashion; that residents should receive quality of care and living environments.
On 6/26/24 at 10:35 AM, the Licensed Nursing Home Administrator (LNHA), in the presence of the DON, Assistant Director of Nursing (ADON), and survey team acknowledged that the wheelchair and resident room, which resulted in the urine smell in the hallway, were not acceptable.
A review of the facility's undated Quality of Life- Homelike Environment policy included .2.
The facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting.
These characteristics include: a.
Cleanliness and order .e.
Pleasant, neutral scents .
A review of the facility's Cleaning and Disinfecting Wheelchairs, [Reclining Chairs, Bedside Commode, & Privacy Curtains policy dated last reviewed March 2024, included . 1.
Ensure that wheelchairs and [reclining chairs] are kept clean and in good repair [ .] 4.
Designate an area for cleaning wheelchairs, [reclining chairs], and bedside commode. If necessary, use a power spray and clean heavily soiled wheelchairs outside .
NJAC 8:39-4.1 (a), 11
According to the Admission Record (AR), Resident #147 was admitted to the facility with the diagnoses which included but not limited to chronic respiratory failure and tracheostomy (hole in the windpipe to facilitate breathing).
The most recent comprehensive Minimum Data Set (MDS), an assessment tool dated 4/10/24, reflected that Resident #147 had moderate cognitive deficits and was dependent on staff for hygiene. Resident #147's individualized comprehensive care plan (ICCP) reflected that the resident required total dependence and one-person physical assistance with personal hygiene.
According to the AR, Resident #32 was admitted to the facility with the diagnoses which included but not limited to cerebral infarction (stroke).
The most recent comprehensive MDS dated [DATE], reflected that Resident #32 had severe cognitive deficits and was dependent on staff for hygiene. Resident #32's ICCP reflected that the staff provided incontinent care every two to four hours and that the resident required total dependence and one-person physical assistance with personal hygiene.
On 6/18/24 at 8:02 AM, the surveyor conducted an incontinence tour on the Second Floor nursing unit accompanied by the Unit Manager/Licensed Practical Nurse (Um/LPN #1) and observed the following:
The surveyor and UM/LPN #1 entered Resident #147's room who was observed lying in bed. UM/LPN #1 asked the resident if she could check their incontinent brief and the resident gave UM/LPN #1 permission.
The surveyor observed that the resident's incontinent brief was dry and the chuck (protective bed pad) that was directly under the resident was dry, however the fitted sheet located under the chuck had a large brown/yellow stain that smelled like urine and contained some dry brown stains which UM/LPN #1 identified as bowel movement (bm). UM/LPN #1 was interviewed at that time, and stated that the Certified Nursing Aide (CNA) that was assigned to care for Resident #32 should have changed the resident's sheet when performing incontinence care and should not have left a urine-soaked sheet on the resident's bed. UM/LPN #1 stated that the Agency CNA that cared for the resident on 11:00 PM to 7:00 AM shift must have left the dirty sheet on the resident's bed because the CNA (CNA #1) that came in that morning just got to the unit and had not made rounds yet. UM/LPN #1 stated that incontinence rounds were completed by the CNA every two hours.
The surveyor observed the resident's skin during the tour and the resident's skin was free of skin breakdown.
A review of the CNA Assignment sheet for 6/18/24, revealed that for the resident census of 47, there were five assigned CNAs. CNA #1 had thirteen assigned residents to care for.
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
According to the Admission Record (AR), Resident #147 was admitted to the facility with the diagnoses which included but not limited to chronic respiratory failure and tracheostomy (hole in the windpipe to facilitate breathing).
The comprehensive Minimum Data Set (MDS), an assessment tool dated 4/10/24, reflected that Resident #147 had moderate cognitive deficits and was dependent on staff for hygiene. Resident #147's individualized comprehensive care plan (ICCP) reflected that the resident required total dependence and one-person physical assistance with personal hygiene.
According to the AR, Resident #32 was admitted to the facility with the diagnoses which included but not limited to cerebral infarction (stroke).
The comprehensive MDS dated [DATE], reflected that Resident #32 had severe cognitive deficits and was dependent on staff for hygiene. Resident #32's ICCP reflected that the staff provided the resident incontinent care every two to four hours, and that the resident required total dependence and one-person physical assistance with personal hygiene.
On 6/18/24 at 8:02 AM, the surveyor conducted an incontinence tour on the Second Floor nursing unit accompanied by the Unit Manager/Licensed Practical Nurse (UM/LPN #1) and observed the following:
The surveyor and UM/LPN #1 entered Resident #147's room who was observed lying in bed. UM/LPN #1 asked the resident if she could check their incontinent brief and the resident gave UM/LPN #1 permission.
The surveyor observed that the resident's incontinent brief was dry and the chuck (protective bed pad) that was directly under the resident was dry, however the fitted sheet located under the chuck had a large brown/yellow stain that smelled like urine and contained some dry brown stains which UM/LPN #1 identified as bowel movement (bm). UM/LPN #1 was interviewed at this time and stated that the Certified Nursing Assistant (CNA) that was assigned to care for Resident #32 should have changed the resident's sheet when performing incontinence care and should not have left a urine-soaked sheet on the resident's bed. UM/LPN #1 stated that the agency CNA that cared for the resident on the 11:00 PM to 7:00 AM shift must have left the dirty sheet on the resident's bed, because the CNA (CNA #1) that came in this morning just got to the unit and had not made rounds yet. UM/LPN #1 stated that incontinence rounds should be done by the CNA every two hours.
The surveyor observed the resident's skin during the tour and the resident's skin was free of skin breakdown.
On 6/18/24 at 8:45 AM, the surveyor conducted an incontinence tour on the First Floor nursing unit with a Licensed Practical Nurse (LPN #1) and observed the following:
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
During entrance conference on 6/17/24 at 10:00 AM, the surveyor asked the Licensed Nursing Home Administrator (LNHA) and Director of Nursing (DON) who the facility's Infection Preventionist (IP) was, and the DON stated the facility's previous IP left about two or three months ago and the position was vacant.
The DON stated herself, the Assistant Director of Nursing (ADON), and the two unit managers reviewed immunizations, antibiotic stewardship, and infection control issues. At that time the surveyor requested a copy of the infection control certifications as well as the date the IP stopped working.
On 6/18/24 at 11:42 AM, the surveyor requested from the LNHA a copy of the infection control certifications and the last date the IP worked.
On 6/19/24 at 12:55 PM, the surveyor requested from the LNHA a copy of the infection control certifications and the last date the IP worked as well as the antibiotic stewardship tracking and surveillance.
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
The survey team informed the facility that there were repeated concerns from the last standard survey which included MDS assessments, medication
what the facility implemented to ensure sustainability.
The LNHA acknowledged that even though she started at the facility in April 2024, she was present for the April quarterly QAPI meeting as well as reviewed and signed the facility assessment and reviewed the CMS 2567 from last standard survey. At that time the DON stated she was aware of the facility's previous deficiencies and that facility educated staff and completed reports.
No additional information was provided.
A review of the facility provided Administrator job descriptions included the Administrator is responsible for planning and is accountable for all activities and departments at [name redacted] subject to rules and regulations promulgated by government agencies to ensure proper health care services to residents.
The Administrator administers, directs, and coordinates all activities of the facility to assure that the highest degree of care is constantly provided to the residents .
A review of the facility provided Senior Director of Nursing Services job descriptions included in addition to the standard responsibilities of Director of Nursing, Senior Director of Nursing is responsible for providing leadership, training and expert guidance.
Individuals selected for this position and must be knowledgeable in all aspects of long term care nursing and have demonstrated ability in managing a nursing department .
Performs Related Duties: 1. in the absence of the Administrator and/or licensed Assistant Administrator, the DON is responsible carrying out the administrative duties of the nursing facility .
NJAC 8:39-33.1(a)(e); 33.2 (a)(b)(c)(d)
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
During entrance conference on 6/17/24 at 10:00 AM, the surveyor asked the LNHA and Director of Nursing (DON) who the facility's Infection Preventionist (IP) was, and the facility did not have an IP for two or three months, that the Assistant Director of Nursing (ADON), two unit managers, and herself reviewed antibiotic stewardship and inserviced staff on infection control.
The surveyor requested a copy of their infection control certifications.
On 6/19/24 at 1:36 PM, the surveyor interviewed the DON who stated she did not have a certification in infection control; but she reviewed infection control with the ADON who also was not certified.
The DON stated only the Unit Manager/Licensed Practical Nurse (UM/LPN #1) had an infection control certification.
The DON stated the unit managers provided the antibiotic stewardship information to the ADON who reviewed, summarized, and completed the monthly report, and the ADON in-serviced staff on infection control.
On 6/20/24 at 12:36 PM, the surveyor interviewed the ADON who stated the facility had no IP since April of 2024, everyone was pitching in with infection control.
The ADON stated she had just completed May's antibiotic stewardship review yesterday.
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
According to the Admission Record, Resident #87 was admitted to the facility with diagnoses including but not limited to diabetes mellitus (a disease of inadequate control of blood levels of glucose), hypertension (high blood pressure), heart failure (heart muscle does not pump blood as well as it should), and stroke (damage to the brain from interruption of its blood supply).
A review of the most recent Minimum Data Set (MDS), an assessment tool dated 3/18/24, reflected the resident had a brief interview for mental status score of 15 of out of 15, indicating a fully intact cognition. A review of Section O0300 indicated Resident #87's pneumococcal vaccine (immunization) was not up to date; that the resident was offered and declined.
A review of Resident #87's Immunization Record revealed no pneumococcal vaccine was administered, but the resident was administered influenza vaccine on 3/11/24.
A review of Resident #87's Progress Notes did not include documentation that the resident was educated, offered, and declined the vaccination.
On 6/20/24, the surveyor requested the Pneumococcal Immunization Informed Consent declination form from the Director of Nursing (DON).
On 6/24/24, a review of a Pneumococcal Immunization Informed Consent, revealed that Resident #87 was offered the pneumonia vaccine on 6/18/24 and declined.
There was no documentation that the resident was offered or that the resident was offered the pneumococcal vaccine prior to survey.
On 6/24/24 at 10:02 AM, the surveyor interviewed the Assistant Director of Nursing (ADON) who stated upon admission, the nurse reviewed the resident's vaccination status.
The ADON stated if there was no documented immunizations received, the nurse offered the immunization and had the resident signed the consent form or declined the immunization on the same form.
The ADON stated the resident was offered the pneumococcal vaccine on 6/18/24, but declined.
The ADON confirmed the facility did not have the resident's declination form from admission.
On 6/26/24 at 10:35 AM, the DON in the presence of the Licensed Nursing Home Administrator (LNHA), ADON, and survey team stated, the resident was offered on admissions, but the facility could not provide documentation.
2.
According to the Admission Record, Resident #76 was admitted to the facility with diagnoses included hypertension (high blood pressure), stroke (damage to the brain from interruption of its blood supply), and end stage renal disease (kidneys can no longer function on their own).
315124
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 315124 B.
Wing 06/26/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Belle Care Nursing and Rehabilitation Center 439 Bellevue Avenue Trenton, NJ 08618
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.