Family of Caring Healthcare at Montclair

In the surveyor’s words

From the most serious findings on record at Family of Caring Healthcare at Montclair, in the surveyor’s own words.

• No harm, potential for more than minimal, isolatedF554Apr 30, 2025

  Based on observation, interview and record review, it was determined that the facility failed to assess a resident's capability to self-administer medication and obtain a physician's order for the resident to self-administer a medication. This deficient practice was identified in 1 of 1 resident reviewed for self-administration (Resident #264) and was evidenced by the following: Refer F697 On 4/22/25 at 11:30 AM, during the initial tour, the surveyor observed Resident #264 in bed, the head of the bed was elevated, the ankle and foot were also elevated off the bed with a pillow. […]

• No harm, potential for more than minimal, isolatedF558Apr 30, 2025

  Based on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to maintain the call bell within reach of residents. This deficient practice was identified for 3 of 17 residents reviewed for accommodation of needs (Resident #10, 14, and 20), and was evidenced by the following: 1. On 4/22/25 at 11:00 AM, the surveyor heard the resident calling out for assistance. The surveyor entered the room and observed Resident # 20 in bed with Oxygen infusing via a Nasal Cannula at 2 Liters per minute (LPM). The surveyor observed the resident's call bell (a bell used to summon staff for assistance) was affixed to the lower aspect of the bedframe, not within his/her reach. […]

• No harm, potential for more than minimal, isolatedF584Apr 30, 2025

  Based on observation and interview, it was determined that the facility failed to maintain the residents' living environment in a clean, sanitary, and homelike manner for 2 of 17 residents (# 14 and #49) reviewed. The deficient practice was evidenced by the following: 1.On 4/22/25 at 12:30 PM, in Resident #49's room, the surveyor observed 3 brown colored circle shaped spots along the resident's window sill. The surveyor also observed dark brown and grey colored streaks on the inside of 2 of 2 of the resident's window pans. The surveyor observed multiple 5 inch long scratches along the bottom of the resident's bathroom door and brown colored debris along the residents bathroom floor. The surveyor also observed brown colored debris along the floor inside the resident's bedroom. […]

• No harm, potential for more than minimal, isolatedF640Apr 30, 2025

  Based on interview and record review, it was determined that the facility failed to complete and transmit a Minimum Data Set (MDS) in accordance with federal guidelines. This deficient practice was identified for 1 of 20 residents reviewed for resident assessment (Resident #47) This deficient practice was evidenced by the following: The surveyor reviewed the facility assessment task that included the Resident's MDS Assessments. The MDS is a comprehensive tool that is federal mandated process for clinical assessment of all residents that must be completed and transmitted to the Quality Measure System. The facility must electronically transmit the MDS up to 14 days of the assessment being completed. The surveyor reviewed Resident #47's electronic medical record. […]

• No harm, potential for more than minimal, isolatedF657Apr 30, 2025

  Based on observation, interview, and record review, it was determined that the facility failed to update and/or revise care plans for 1 of 20 residents reviewed, Resident # 49. The deficient practice was evidenced by the following: The surveyor reviewed an investigation for a fall Resident #49 had. The fall occurred on 2/1/25. The investigation determines that Resident # 49 had new onset of confusion and was weak and attempted to get out of bed unassisted and the resident fell. The facility's Interdisciplinary team determined that the use of bedside mats and a low bed would prevent injury should the resident fall again. A review of the residents' care plan for falls revealed that the interventions from the fall of 2/1/25 were not included in the resident's active care plans. […]