Based on observation, interview and record review, it was determined that the facility failed to administer medication with an error rate of less than 5%. The surveyor observed 4 nurses administer medications for 7 residents; errors were observed for 1 of 7 residents (Resident #12). There were 25 opportunities for error with 2 errors observed resulting in an error rate of 8% as evidenced by the following:During the medication pass observation on 08/14/2026 from 9:16 AM until 9:41 AM, the surveyor observed the following: At 9:16 AM, the surveyor observed Licensed Practical Nurse #1 (LPN #1) prepare 7 medications for Resident #12, which included the following: 1. …
F759 citations in New Jersey
Medication error rate · Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
New Jersey cites F759 more often than its own record predicts
1.36 times the share F759 takes of citations nationally.
Of every deficiency written in New Jersey in 2025, this is the portion that was F759.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What New Jersey surveyors wrote
F759 findings written in New Jersey, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
The short window
Recent years
| Year | Share of New Jersey citations | vs expected |
|---|---|---|
| 2023 | 1.35% | 1.10× |
| 2024 | 1.26% | 1.17× |
| 2025 | 1.47% | 1.36× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else New Jersey surveyors cite →
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