De la Salle Hall

In the surveyor’s words

From the most serious findings on record at De la Salle Hall, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880Jan 27, 2021

  Based on observation, interview, medical record review and other facility documentation, it was determined that the facility failed to implement mitigation strategies to prevent the transmission of COVID-19 by not appropriately utilizing Personal Protective Equipment (PPE) for residents identified as exposed to COVID-19 for 27 of 27 residents, and for 4 of 4 residents, Resident #4, #5, #6 and #7 who were readmitted to the facility and identified as persons under investigation (PUI). This deficient practice placed 27 of 27 residents in the facility at risk for infection. […]

• No harm, potential for more than minimal, widespreadF812May 15, 2026

  Based on observations, interviews, and review of facility provided documents, it was determined that the facility failed to maintain proper kitchen sanitation practices by keeping the kitchen door closed and consistently recording water temperatures and chemical sanitizer levels, to prevent the potential development of food borne illness. This deficient practice was evidenced by the following:On 5/12/26 at 5:23 PM, during the initial tour of the facility, the surveyor walked past a door to the kitchen which was completely open to a hallway used by residents, staff, and/or visitors. The surveyor observed a staff member in the kitchen putting food onto plates. A sign on the open door indicated to keep the door closed at all times. […]

• No harm, potential for more than minimal, widespreadF812Aug 20, 2021

  Based on observation, interview, and review of pertinent documentation, it was determined that the facility failed to a.) store potentially hazardous foods in a manner to ensure safe food temperatures are maintained, and b.) store foods in a manner to ensure items are not used beyond safe use by dates. This deficient practice was evidenced by the following: On 08/18/21 at 09:15 AM, the surveyor toured the kitchen in the presence of Food Service Director (FSD) and two other surveyors and observed the following: 1. The large walk-in refrigerator with attached walk-in freezer had an August 2021 temperature log that was blank. The FSD informed the surveyor that, It got dirty, so this is new one. […]

• No harm, potential for more than minimal, widespreadF886Jan 27, 2021

  Based on interview and review of facility documentation, it was determined that the facility failed to test staff for Coronavirus Disease 2019 (COVID-19) at a frequency based on the COVID-19 Activity Level Index (CALI) Weekly Report. This deficient practice was identified for 3 of 3 staff members in the facility who were reviewed for COVID-19 testing and was evidenced by the following: During an interview with the surveyor on 1/25/21 at 9:50 am, the Administrator stated that the staff were tested weekly on Mondays for COVID-19. The Administrator stated testing for staff was based on guidance form the local health department and the Executive Orders for New Jersey. The Administrator stated the current positivity was .97%. […]

• No harm, potential for more than minimal, patternF658Dec 31, 2024

  Based on observations, interview, and review of pertinent facility documents, it was determined that the facility failed to document weekly weights as ordered in accordance with professional standards of practices. This deficient practice was identified for 1 of 12 residents reviewed for professional standards of practice (Resident #10). The deficient practice was evidenced by the following: 1. On 12/26/24 at 10:35 AM, during initial tour of the facility, the surveyor observed resident #10 in their bedroom seated in their wheelchair. At the time Resident #10 had a visitor present and reported no concerns. […]