Clover Rest Home

In the surveyor’s words

From the most serious findings on record at Clover Rest Home, in the surveyor’s own words.

• Immediate jeopardy, patternF880Mar 9, 2021

  C#: NJ 3 Based on observations, interviews, review of medical records, and other pertinent facility documentation on 3/5/2021, it was determined that the facility failed to ensure that appropriate Transmission Based Precautions ( TBP) were practiced by healthcare staff while caring for a resident ( Resident #2) who had been placed on Persons Under Investigation ( PUI) and isolation droplet precautions for possible exposure to COVID-19. The staff were not using appropriate Personal Protective Equipment ( PPE) according to the Centers for Disease Control ( CDC) guidelines, New Jersey Department of Health Executive Directive Number ( NO) 20-026 and facility polices and procedures for infection control when entering a PUI resident room and leaving to enter 2 non-PUI residents rooms ( Resident… […]

• No harm, potential for more than minimal, widespreadF912Jan 26, 2024

  Based on observations and interview on 01/25/2024 and 01/26/2024, it was determined that the facility failed to provide at least 80-square feet per Resident bed in multi-bedded rooms or 100-square feet in a single bedded room as evidenced by the following: On 01/25/2024 during the survey entrance at approximately 10:01 AM, a request was made to the Administrator and Director of Maintenance (DOM) to provide a copy of the facility lay-out which identifies the various rooms and smoke compartments in the facility. A review of the facility provided lay-out identified the facility is a three-story (3) building with a basement. […]

• No harm, potential for more than minimal, isolatedF695May 7, 2025

  Based on observation, interview, and record review, it was determined that the facility failed to ensure that oxygen tubing was stored in accordance with infection control measures. This was found with 1 of 2 residents who received oxygen therapy, Resident #180. The deficient practice was evidenced by the following: On 5/1/25 at 11:25 AM, the surveyor observed Resident #180 in the day room participating in the activities. The surveyor observed a portable oxygen tank on the back of the wheel chair with oxygen tubing including the nasal cannula (NC) portion of tubing hanging off the tank, touching the floor and was not in use and not stored in a bag. The surveyor interviewed the Certified Nursing Assistant (CNA), who stated that the tubing should not have been on the floor. […]

• No harm, potential for more than minimal, isolatedF641Jan 26, 2024

  Based on observation, interview, and record review it was determined that the facility failed to accurately code the Minimum Data Set (MDS), an assessment tool used to facilitate the management of care, in accordance with Federal guidelines for 1 of 15 residents, Resident #8 reviewed for accuracy for MDS coding. This deficient practice was evidenced by the following: On 1/22/24 at 11:41 AM, the surveyor observed Resident #8 sitting in a wheelchair with other residents in the day room for recreational activity. The resident was resting in the wheelchair with there eyes closed. There was no urinary catheter observed. On 1/24/24 at 9:40 AM, the surveyor reviewed the electronic and paper medical record for Resident #8. […]

• No harm, potential for more than minimal, isolatedF658Jan 26, 2024

  Based on observation, interview, and review of medical records, it was determined that the facility failed to follow professional standards of practice by a.) not acquiring physician's order (PO) for the administration of Oxygen, b.) not administering the medication as ordered by the Physician and c.) by not following the facility's policy for (Peripherally Inserted Central Catheter) PICC line medication administration. This deficient practice was observed for 1 of 15 residents reviewed, Resident #19, Resident #5 and Resident #127 as evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45, Chapter 11. Nursing Board. […]