Above average — CMS composite of the measures below.
The next survey window likely opens around March 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Tri-county Nursing Home during CMS and state inspections, most recent first.
A facility record review found repeated gaps in documentation for insulin refusals, high BG readings, and other omitted meds, with no progress note evidence that the MD or APRN was notified as required. Several residents with DM had MAR entries showing refused insulin, sleeping at med times, or BG values above notification thresholds, yet the chart lacked corresponding physician-notification documentation. The record also showed a resident’s family was not documented as being notified of changes in condition, including respiratory symptoms and flu-like illness.
Staff in an LTC facility failed to perform proper hand hygiene and use PPE, leading to potential infection risks. An LPN repeatedly neglected hand hygiene between resident interactions, while a CNA did not sanitize hands before and after donning gloves. Additionally, staff did not adhere to Enhanced Barrier Precautions for a resident with multiple medical conditions, failing to wear gowns during high-contact activities. These actions were inconsistent with the facility's infection control policies.
A resident did not receive prescribed nutritional shakes with meals, as observed during multiple meal times. Despite a physician's order and the resident's documented weight loss, the facility failed to provide the necessary supplements due to a lapse in checking dietary requirements. Staff interviews confirmed the oversight, highlighting a breach in the facility's nutrition policy.
A facility failed to document oxygen therapy for a resident as per physician's orders. Observations showed the resident receiving oxygen, but records lacked documentation for two days. The DON admitted the orders should have been updated for continuous oxygen, and an LPN overlooked the as-needed order. The facility's policy required documentation of all services, which was not followed.
Inaccurate medication and change-in-condition documentation
Penalty
Summary
The facility failed to keep resident records accurate for medication management and for changes in condition. Review of multiple residents’ MARs and progress notes showed repeated medication refusals, omitted doses, and blood glucose values above ordered notification parameters without corresponding documentation that the physician or APRN was notified. The deficiency involved residents with diabetes who were receiving scheduled insulin and other medications, including residents with orders to notify the MD for blood sugars over 400 or when medications were refused. For one resident, the MAR showed insulin glargine was refused on two mornings, and the progress notes did not document physician notification. The same resident had several blood glucose readings above 400 while receiving sliding-scale Novolog, but the nursing notes did not show physician notification for those elevated values. During interview, the APRN stated she knew the resident refused medications and insulin and had sugars over 400, and that staff would text her about refusals. Another resident’s MAR showed insulin glargine was documented as refused, no insulin required, or other/see progress notes on several dates, but the progress notes did not document physician notification. The record also showed the resident requested and received half doses of insulin glargine on multiple occasions, yet there were no physician orders dated for those reduced doses. The DON stated communication with physicians should be documented in the eMAR notes or progress notes, and the Medical Director and APRN stated they were aware the resident frequently refused insulin and that staff would notify them. A third resident had numerous insulin refusals documented on the MAR across March and April, but the progress notes did not document physician notification for those refusals. A fourth resident had repeated insulin refusals and sleeping entries on the MAR, and the progress notes did not show documentation that the physician or nurse practitioner was notified when insulin or accu-checks were refused or when the resident was asleep at medication times. Staff stated they normally document physician contact in the progress note, and the Medical Director stated the facility staff notified him or the nurse practitioner at all hours. The report also identified a change-in-condition documentation issue for another resident. The resident’s record showed a pulmonary consult and chest x-ray were ordered for coughing with eating, chest pain, vomiting/regurgitation, and later flu-like symptoms with Tamiflu ordered after the MD was informed. However, the nursing notes did not document that the resident’s family was notified of these changes in condition. The DON reviewed the record and stated there was no documentation that the family had been notified. Additional record review showed another resident had repeated high blood glucose readings over 400 with sliding-scale Novolog orders that required MD notification, but the nursing progress notes did not document physician notification. The same resident’s MAR also showed frequent refusals of aspirin, atorvastatin, carvedilol, clopidogrel, Colace, Farxiga, furosemide, Januvia, lisinopril, protein supplement, and Prozac, with progress notes stating the resident refused medications or was sleeping, yet there was no documentation that the physician was notified of the refusals. The physician stated he and the nurse practitioner were notified through the messaging system about high blood sugars and medication refusals. A fifth resident’s record showed insulin glargine and insulin aspart were documented as refused or not given on multiple dates, but the progress notes did not document physician notification of the refusals. Staff stated they notify the MD and reeducate residents when insulin is refused, and the physician stated the resident had long been reluctant to take insulin and that refusals were reported to him or the nurse practitioner.
Inadequate Hand Hygiene and PPE Use in LTC Facility
Penalty
Summary
The facility failed to ensure proper hand hygiene and use of personal protective equipment (PPE) by staff, leading to potential infection risks. Observations revealed that a Licensed Practical Nurse (LPN), identified as Staff D, repeatedly neglected to perform hand hygiene between resident interactions. This included administering medications to multiple residents without washing hands or using hand sanitizer, even after handling potentially contaminated items such as a box of cigarettes and a water container. Interviews with the Infection Preventionist and the Director of Nursing confirmed that hand hygiene should be performed between each resident contact, which Staff D acknowledged knowing but failed to practice. Additionally, a Certified Nursing Assistant (CNA), identified as Staff A, was observed not performing hand hygiene before and after donning gloves while assisting a resident with a transfer. Staff A also failed to perform hand hygiene after handling equipment and before entering another resident's room. The Assistant Director of Nursing emphasized that gloves do not replace the need for hand hygiene, and staff are expected to sanitize their hands every time they enter a room and come into contact with residents or surfaces. The facility also did not adhere to Enhanced Barrier Precautions (EBP) for a resident with multiple medical conditions, including sepsis and a urinary tract infection. Staff B and Staff C, both CNAs, entered the resident's room without wearing gowns, despite the requirement for gown and glove use during high-contact activities such as repositioning the resident. The Director of Nursing's statements conflicted with the facility's policy, which mandates PPE for specific high-contact activities. This inconsistency in practice and policy further contributed to the deficiency in infection control measures.
Failure to Provide Prescribed Nutritional Supplements
Penalty
Summary
The facility failed to ensure that a resident received the prescribed nutritional supplements, specifically a health shake, with meals. During multiple observations, it was noted that the resident's meal trays did not include the nutritional shake as ordered by the physician. The resident, who had a documented weight loss of 0.68% over a month, was observed consuming only a small portion of her meals, which further emphasized the importance of the nutritional supplement. Interviews with staff, including CNAs and the Dietary Manager, revealed that the health shakes were supposed to be provided by the kitchen with the meal trays, but this did not occur due to a failure to check the list of residents requiring nutritional supplements. The Registered Dietitian acknowledged the resident's poor appetite and the need for both Med Pass and health shakes to support her nutritional intake. Despite this, the resident did not receive the health shakes as required. The Dietary Manager admitted that the kitchen aide missed checking the list of residents who needed nutritional shakes, leading to the oversight. The facility's policy on Food and Nutrition Services mandates that each resident is provided with a diet that meets their nutritional needs, but this was not adhered to in the case of the resident in question.
Failure to Document Oxygen Therapy for Resident
Penalty
Summary
The facility failed to ensure accurate medical records for a resident receiving oxygen therapy. During observations on two consecutive days, the resident was noted to be receiving oxygen via nasal cannula, but there was no documentation of this oxygen use in the Treatment Administration Record for those days. The physician's order for the resident specified titrating oxygen for saturations below 90%, starting at 2 liters per minute and increasing as needed, with a requirement to notify the medical doctor if saturations fell below 90%. However, the resident's records did not reflect the administration of oxygen as per the physician's order. Interviews with facility staff revealed a lack of awareness and oversight regarding the resident's oxygen orders. The Director of Nursing acknowledged that the resident's orders should have been updated to reflect continuous oxygen use, and staff were expected to document services provided. A Licensed Practical Nurse admitted to overlooking the as-needed order for oxygen, indicating a gap in the documentation process. The facility's policy on charting and documentation emphasized the need for recording all services provided to residents, yet this was not adhered to in the case of the resident receiving oxygen therapy.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Trenton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Ayers Health And Rehabilitation Center | 6.8 mi | ★★★★★ | 1 | 1 |
| Cross City Nursing And Rehabilitation Center | 12.7 mi | ★★★★★ | 5 | 0 |
| Terrace Healthcare & Rehabilitation Center | 28.7 mi | ★★★★★ | 7 | 0 |
| Aviata At North Florida | 30.8 mi | ★★★★★ | 23 | 3 |
| Magnolia Ridge Health And Rehabilitation Center | 31.2 mi | ★★★★★ | 7 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.