State issued corrective action plan, admissions freeze for Princeton Care Center in August due to deficiencies, staffing shortages

The New Jersey Department of Health issued a corrective action plan to the Princeton Care Center and banned the facility from accepting new residents starting in early August due to widespread deficiencies at the long-term care facility, which also had a staffing ratio lower than what is mandated by state law, state documents show.

Staff members from the New Jersey Department of Health were on-site at Princeton Care Center from June 27 through July 13 conducting an investigation in response to a complaint. During the inspection, the surveyors identified 27 deficiencies on the federal health survey, including three widespread deficiencies causing “no actual harm but with the potential for more than minimal harm that is not immediate jeopardy.” Three of the 27 deficiencies were considered substandard quality of care in the areas of “freedom from abuse, neglect and exploitation,” quality of life, and quality of care. The surveyors also cited the facility for seven “life safety” code deficiencies.

Inspectors determined that the facility failed to develop and implement a comprehensive written abuse policy and procedures to protect residents and ensure that the identification and investigation of all types of potential abuse took place. There was no process in place to ensure staff reported all potential abuse of residents in their care.

The facility also did not have a system in place to ensure that staff members could accurately identify a resident’s code status in an emergency situation and follow a physician’s order for code status, according to state inspectors. A code status informs medical professionals of a person’s wishes if the person’s heart stops beating or they stop breathing.

Princeton Care Center also failed to ensure that staff were competent in providing the appropriate care for dialysis patients, according to inspectors.

The facility also failed to ensure that nursing and other services were provided for residents to maintain their highest possible level of physical, mental, and social well-being. The facility did not properly take care of residents’ nails and did not provide thickened liquids that had been ordered by a doctor, according to state inspectors.

Princeton Care Center also violated the state’s staffing law by not meeting minimum staffing requirements, according to inspectors. The facility did not have enough certified nursing aides (CNAs), the employees who are on the front lines providing basic care for residents such as changing diapers, bathing residents, and adjusting bed positions with cushions for residents who are not mobile so residents don’t get bed sores.

For a 35-day period in the fall of 2022, Princeton Care Center failed to have adequate staffing for 30 of 35 days. For 83 residents, the facility was required to have 10 CNAs. On two days, the facility only had five CNAS on a shift serving 82 patients, or half the number required. On four days the facility only had six CNAs on a shift.

The situation did not improve in the spring of or June of 2023. The facility failed to have enough CNAs 14 out of 14 days in both the spring and again in June.

Due to the repeated inability to have enough staff members to serve residents’ needs and deficiencies found at the facility, the state restricted admissions in early August, only allowing readmissions for people returning to the facility from medical facilities.

The corrective action plan developed by the state required the Princeton Care Center to have a full-time, licensed nursing home administrator consultant on-site. The administrator was required to assess the facility’s compliance with state licensing requirements, identify areas of noncompliance, oversee the development of corrective action plans, implement compliance management systems at the facility, work with facility leadership to make sure operations aligned with state compliance requirements, make sure staff training met state licensing standards, and take any other actions necessary to make sure the facility complied with state standards.

As part of the corrective action plan, the facility was also required to hire a full-time registered nurse consultant to work with the director of nursing to make sure that all staff caring for patients were competent when it came to identifying a resident’s code status in an emergency situation, and competent to provide care for dialysis patients. The consultant was also tasked with making sure staff members were educated about proper hand hygiene.

Princeton Care Center was required to hire both of the consultants and have them start work by Aug. 18. The company was not allowed to hire anyone with previous ties to the facility or its owners, management, or employees.

The state required that Princeton Care Center submit weekly reports that identified areas of non-compliance, listed corrective measures to correct those areas, and gave an update on the status of implementing those measures. The weekly report, due each Friday at 1 p.m., also required the Princeton Care Center to provide projected CNA and nurse staffing numbers for the following week, actual CNA and nurse staffing for the current week, and evidence that training had been completed and staff members were competent.

According to the order, failure to comply with the corrective action plan would result in financial penalties. The order was issued verbally on Aug. 2 and in writing Aug. 9. On Aug. 31, the company that owns Princeton Care Center could not make payroll. The facility abruptly closed down Sept. 1, with residents and their loved ones only being given hours to find new homes.