Princeton Nursing & Rehabilitation

In the surveyor’s words

From the most serious findings on record at Princeton Nursing & Rehabilitation, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Sep 13, 2024

  Based on observation, interview, and review of facility policy, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. Observation on 09/08/2024 of the reach-in cooler revealed multiple food items which had been opened; however, were not labeled and undated. The facility's failure had the potential to affect 96 of the facility's 98 residents who consumed food from the kitchen. The findings include: Review of the facility documents titled,Safe Standards and Procedures, Food Handling, dated 03/08/2024, from the facility's contracted kitchen services provider, revealed, foods, intended for storage beyond 24 hours, must be labeled. […]

• No harm, potential for more than minimal, isolatedF656Sep 13, 2024

  Based on observation, interview, record review and review of facility policy, it was determined the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, with measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs as identified in the comprehensive assessment for two (2) of three (3) sampled residents. (Resident (R)38), and R26. The facility care planned R38 for alteration in nutritional status related to receiving enteral (tube) feedings, with interventions that included elevating the head of bed (HOB) during feedings, and maintaining the resident in an upright posture to decrease aspiration risk. […]

• No harm, potential for more than minimal, isolatedF657Sep 13, 2024

  Based on observation, interview, record review, and review of the facility policies, the facility failed to ensure the comprehensive care plan was reviewed and revised by its Interdisciplinary Team (IDT following a fall with major injury for 1 of 22 sampled residents, Resident (R)26. On 06/23/2024 a perimeter defining mattress (PDM) was recommended as an intervention by the IDT for R26, and a PDM was placed on the resident's bed. The PDM was removed at R26's request; however, was not added to the resident's falls care plan to accurately reflect the resident's plan of care. In addition, R26's falls care plan noted a high rise mattress r/t fall from bed remained as an active intervention, but was not observed to be in use. […]

• No harm, potential for more than minimal, isolatedF684Sep 13, 2024

  Based on observation, interview, record review, and review of facility policy, the facility failed to ensure medical provider orders were entered upon receipt for 1 of 22 sampled residents, Resident (R)26. On 06/25/2024 at 11:11 AM, Registered Nurse (RN) 3 contacted the Advanced Practice Registered Nurse (APRN) 1 to report R26 had right leg pain, scattered bruising of the right leg and swelling of the right knee. RN 3 said APRN 1 ordered an x-ray of R26's right leg the previous night. Review of the medical record revealed no documented evidence of an x-ray order or documentation of the nurse's communication with APRN 1 on 06/24/2024. […]

• No harm, potential for more than minimal, isolatedF689Sep 13, 2024

  Based on observation, interview, record review, and review of facility policy, the facility failed to ensure the use of assistive devices to prevent injury for 1 of 3 sampled residents, Resident (R)26. Review of the Physician's Order History revealed an order with a start date of 03/29/2023 and a discontinue date of 9/11/2024 for High rise mattress as intervention r/t falls from bed. However, observation of R26's bed mattress revealed a standard mattress was in place, not the ordered high rise mattress. […]