Aspen Hills Healthcare Center

In the surveyor’s words

From the most serious findings on record at Aspen Hills Healthcare Center, in the surveyor’s own words.

• Immediate jeopardy, patternF600Oct 31, 2025

  Complaint #: 2594123 Based on observation, interviews, record review, and review of pertinent facility documents, it was determined that the facility failed to implement their abuse policy to ensure residents were protected from physical abuse after a cognitively impaired resident (Resident #2) was found with a bruise to their left clavicle (collar bone) of unknown origin on 8/17/25. This deficient practice was identified for 1 of 5 residents reviewed for abuse (Resident #2). On 8/17/25, staff observed a faint discoloration and minor swelling to Resident #2's left clavicle at approximately 12:20 PM. At the time, the Licensed Practical Nurse/Supervisor (LPN/S #1) did not immediately initiate an investigation. […]

• Immediate jeopardy, patternF610Oct 31, 2025

  Complaint #: 2594123 Based on interviews, record review, and review of pertinent facility documentation, it was determined that the facility failed to immediately implement its abuse and neglect policy by immediately investigating an injury of unknown origin that was discovered on 8/17/25, to protect the resident to rule out abuse. On 8/17/25, a cognitively impaired resident (Resident #2) was noted to have discoloration and minor swelling to the left clavicle (collar bone), and it was determined to be a clavicle fracture on 8/18/25. This deficient practice was identified for 1 of 5 residents reviewed for abuse (Resident #2). On 8/17/25, staff observed a faint discoloration and minor swelling to Resident #2's left clavicle at approximately 12:20 PM. […]

• Actual harm, isolatedF656Dec 15, 2021

  Complaint Intake #NJ 8 Based on interviews and record reviews, it was determined that the facility failed to develop, implement, and revise a comprehensive care plan needed to outline interventions to care for one (Resident #1) of three sampled residents on tube feedings and at risk for aspiration. Resident #1 was left lying flat and aspirated (tube feeding entered the airway and lungs) on 08/11/2021. A care plan was not developed for aspiration pneumonia, and Resident #1 was sent to the hospital again on 10/29/2021 to rule out aspiration pneumonia. Findings included: 1. […]

• Actual harm, isolatedF693Dec 15, 2021

  Complaint Intake #NJ 8 Based on interviews, record reviews, and facility policy reviews, it was determined that the facility failed to prevent complications from enteral (tube) feedings for one (Resident #1) of three residents reviewed for tube feedings. This deficient practice resulted in Resident #1 being found cyanotic (blue), and being admitted to the hospital and diagnosed with aspiration pneumonia (tube feeding in airway and lungs) due to lying flat in bed while the tube feeding was infusing. Resident #1 was then found in respiratory distress and was admitted to the hospital with aspiration pneumonia a couple of months later. Findings included: 1. […]

• No harm, potential for more than minimal, widespreadF880Dec 30, 2025

  Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to a.) maintain clean laundry that was stored in the service corridor in a safe and sanitary manner and b.) follow the recommendations for the use Personal Protective Equipment (PPE) during incontinence care for residents who required Enhanced Barrier Precautions (EBP) (an infection control strategy focused on reducing the spread of multidrug-resistant organisms [MDRO] in nursing homes), to prevent the potential spread of infection in accordance with the Center for Disease Control (CDC), Infection Prevention guidelines and standards of clinical practice.This deficient practice was identified for 7 residents (Resident # 183, #21, #78, #90, #162, #145, and #42) observed for… […]