Daughters Of Israel Pleasant Valley Home
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
from the toilet seat to the w/c. The nurse went to the room and observed Resident #3 on the bathroom floor
on their knees, crying. Resident #3 complained of pain in their right knee. All responsible parties were notified. The Nurse Practitioner ordered an X-ray of the right knee and an order for the rehabilitation department to screen for treatment from the occupational and physical therapy department.
Further review revealed that Resident #3 was transferred to the hospital Emergency Department due to complaints of knee pain. All testing proved negative for injury. The resident was readmitted to the facility on antibiotics for a urinary tract infection.
On 11/10/25 at 12:15 PM, S #2 conducted a telephone interview with the assigned CNA (CNA #3) who transferred Resident #3 without the assistance of a second staff member. CNA #3 stated that she was not aware that the resident required two staff members for transfers and that she should have checked the resident's plan of care before transferring them.
On 11/10/25 at 1:10 PM, during an interview with S #2, the RNMDSC confirmed that Resident #3 had been care-planned as dependent on two staff members for all transfers, effective from 1/18/24 to the present.
On 11/10/25 at 1:20 PM, the survey team discussed the above observations and concerns with the ED, AAIT, and the DON. The DON confirmed that CNA #3 should have followed the resident's CP for a two-person transfer.
A review of the facility's Accident/Incident Report Policy that was provided by the DON, with a reviewed date of 7/2025, revealed that it was the facility's policy to document and investigate all incidents that involve residents, whether or not injury occurs.Procedure:.3. The person completing the report will interview any witnesses to the event to determine what occurred. Any witness (es) to the accident & incident (A&I) will give a written, signed statement indicating any knowledge or information they have pertaining to the incident.6. All sections of the A&I Report are to be completed.These statements will be submitted to the Supervisor after entering the statement into electronic medical records.
A review of the facility's Fall Policy and Procedure that was provided by the DON, with a reviewed date of 7/2025, revealed that it was the facility's policy to document and investigate all falls that involve residents, whether or not injury occurs.Procedure:.3. The person completing the report will interview any witnesses to
the event to determine what occurred. Any witness (es) to the A&I will give a written, signed statement indicating any knowledge or information they have pertaining to the incident.6. All sections of the A&I Report are to be completed.These statements will be submitted to the Supervisor after entering the statement into electronic medical records.
A review of the facility's Care Planning Policy that was provided by the DON with a revised date of 1/2025, revealed that there was no information about CP update and revision.
No further information was provided by the ED.
NJAC 8:39-27.1 (a); 33.1(d)
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
DAUGHTERS OF ISRAEL PLEASANT VALLEY HOME in WEST ORANGE, NJ inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in WEST ORANGE, NJ, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from DAUGHTERS OF ISRAEL PLEASANT VALLEY HOME or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.