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 Concord Healthcare & Rehabilitation Center during CMS and state inspections, most recent first.
Improper food and trash storage in kitchen and dry storage areas: surveyors observed uncovered trash bins, one used to prop open a kitchen door, with the liner touching a bussing cart holding unopened beverages and unused disposable items. In dry storage, a box of overripe bananas was found, along with onions stored in a crate on the floor with an untied liner, and a greasy stained box of unused coffee filters was also observed.
Garbage containers were left open and debris was scattered around the dumpster area and parking lot. Surveyors observed milk crates, carts, cardboard boxes, an untied trash bag, and other debris on the ground, while 2 dumpsters were not fully covered when not in use. The FSD stated dumpsters should be covered at all times except when being used, and facility policy required outside refuse containers to have tightly fitting lids or covers and to be kept covered when not being loaded.
Tube feedings were not consistently administered as ordered for two residents with G-tubes and significant cognitive or swallowing impairments. Surveyors observed pumps turned off with no formula or water infusing, and the MARs showed multiple late TF administrations, some without any documented reason. Staff interviews confirmed that late TFs and refusals should be documented in progress notes, but this was not always done.
Late Medication Administration Exceeded Required Time Frame: An RN prepared and later administered a resident’s scheduled meds after the ordered times, including a beta blocker, Entresto, a diuretic, and an anticoagulant. The EMAR showed the meds were due at 8:00 AM and 9:00 AM, but they were not given until later, and the RN acknowledged the meds were administered late. The DON stated meds should be given within 1 hour before or after the scheduled time, consistent with the facility’s med administration policy.
Failure to Use Required PPE for EBP and Contact Precautions: A CNA provided hygiene-related care to a resident on EBP while wearing gloves but no gown, despite signage and PPE at the doorway. In a separate event, a phlebotomist entered the room of a resident on CP for MRSA and drew blood while wearing gloves but no gown or mask. Both residents had tube feeding and indwelling devices, and the records and care plans identified transmission-based precautions for their care.
The facility failed to maintain the ice machine in a sanitary condition, as black mold was found in the dispenser shoot. The FSD acknowledged the issue, noting that the machine was cleaned quarterly but required more frequent maintenance. The LNHA and DON confirmed the findings, highlighting a lapse in adhering to the facility's policy and manufacturer's guidelines for regular cleaning and sanitization.
A fire alarm pull box in the facility's kitchen was obstructed by a steel table used as an extension of the dishwashing machine table, blocking access to the alarm. This deficiency was confirmed during an interview with the AIT and reported at the Life Safety Code exit conference.
The facility did not meet the required minimum direct care staff-to-resident ratios for 4 of 14 day shifts, as mandated by New Jersey law. On specific days, the number of CNAs was insufficient for the number of residents, despite the facility's use of an "alert system" to contact agency nurses for call-outs. The Licensed Nursing Home Administrator acknowledged the staffing deficiencies during an interview.
Improper Food and Trash Storage in Kitchen and Dry Storage Areas
Penalty
Summary
The facility failed to store potentially hazardous foods and other food-related items in a manner that would prevent foodborne illness, and it failed to maintain kitchen sanitation consistently. During an initial kitchen and food storage tour, a large gray trash bin next to the walk-in refrigerator was uncovered, with its lid on the floor, and contained celery stalks, a plastic container of seasoning, and water bottles mixed in with trash. Another uncovered trash bin was being used to prop open the kitchen door to the hallway, and its liner touched the handle of a bussing cart that held unopened soda cans and water, as well as unused packets of sugar, wipes, paper napkins, plastic cutlery sets, and disposable plastic cups on different shelves. In the bulk/dry storage area, the surveyor also observed a large box of overripe browned bananas, which the cook identified as garbage and removed from the area, and a green crate on the floor lined with an untied plastic bag containing several red onions with the liner spread around the crate and touching the floor.
Garbage Containers Left Open and Debris Left in Dumpster Area
Penalty
Summary
The facility failed to provide a sanitary environment for residents, staff, and the public by not keeping the garbage container area and parking area free of garbage and debris and by not keeping 2 of 2 garbage containers/dumpsters covered when not in use. During observation on 4/6/2026, the surveyor saw 2 green, 1 blue, and 1 grey plastic milk crates scattered in the parking lot next to a grey SUV. During the tour of the designated garbage area with the AIT, the surveyor observed a green garbage dumpster/compactor that was half-open with no staff loading trash into it, and the surveyor observed [NAME] roll the lid on the green dumpster. The surveyor also observed several plastic milk crates on the ground, 2 grey plastic carts near the dumpster area, and a red dumpster for recyclable trash with one of its 2 plastic lids in the open position while nobody was loading anything into it. The area surrounding the dumpsters had garbage on the ground, including an untied red plastic bag, a milk crate, folded cardboard boxes, and other unidentified debris. On interview, the FSD stated that dumpsters should be covered at all times except when being used, and the facility policy stated that refuse containers and dumpsters kept outside the facility shall have tightly fitting lids, doors, or covers and be kept covered when not being loaded.
Tube feedings were repeatedly administered late or not documented as ordered
Penalty
Summary
Enteral nutrition was not administered according to physician orders for two residents who received tube feedings. One resident was admitted with traumatic brain injury, ileus, and protein-calorie malnutrition, had moderate cognitive impairment, and was ordered Jevity 1.5 via tube feeding at 4 PM daily with NPO status. Survey observations on 4/6/2026 and 4/7/2026 found the tube feeding pump off and no formula or free water being administered. The resident’s medication administration record showed the feeding was repeatedly hung late on multiple days, including several instances where it was administered hours after the scheduled time, and one note documented that the resident was put to bed after dinner service and the tube feeding was started at 7 PM. The second resident was admitted with dysphagia, gastrostomy status, and dementia, had severely impaired cognition, and received nutrition through tube feeding. Survey observations on 4/6/2026 found the tube feeding pump off with no formula or free water being administered, while a later observation on 4/7/2026 found Jevity 1.5 infusing with water hydration. The resident had orders for tube feeding at 6 PM, later changed to a 4 PM schedule, and the medication administration audit showed multiple late administrations across March and April 2026. Some late entries had no documented reason, while others were documented as refused due to nausea, vomiting, or because the feeding had been held earlier in the day due to vomiting. Interviews with the LPN/UM, RD, RN, and DON confirmed that tube feedings were expected to be given at the ordered time and that late administration or refusal should be documented in the record, generally in progress notes. The RN stated that documentation was not always completed because there was not always time to document. The facility policy titled Enteral Nutrition stated that adequate nutritional support through enteral nutrition is to be provided to residents as ordered.
Late Medication Administration Exceeded Required Time Frame
Penalty
Summary
The facility failed to ensure that the medication error rate was not 5% or greater. During observation on 04/07/2026 at 10:05 AM on the B Unit, RN #1 prepared medications for Resident #80 and removed one Metoprolol Tartrate 25 mg tablet, two Sacubitril-Valsartan 15-16 mg Sprinkle Capsules, one Furosemide 20 mg tablet, and one Apixaban 2.5 mg tablet into a medication cup. The EMAR showed that Metoprolol was scheduled for 8:00 AM and Entresto, Furosemide, and Eliquis were scheduled for 9:00 AM, but the medications were not administered at those times. At 10:32 AM, RN #1 entered the resident’s room and administered the medications, and at 10:34 AM RN #1 acknowledged that the medications were given late. During interview on 04/09/2026 at 12:30 PM, the DON stated that medications should be given up to one hour before to one hour after the scheduled time. The facility policy titled "Administering Medications," revised February 2026, stated that medications are administered in accordance with prescriber orders, including any required time frame, and that medications are administered within one hour of their prescribed time.
Failure to Use Required PPE for EBP and Contact Precautions
Penalty
Summary
The facility failed to follow appropriate use of PPE during care for residents requiring Enhanced Barrier Precautions (EBP) and Contact Precautions (CP). For one resident with ESBL resistance, a neuromuscular bladder disorder, an open penile wound, tube feeding, and an indwelling urinary catheter, a CNA was observed shaving the resident and wiping the resident’s face while wearing gloves but no gown, despite EBP signage on the door and PPE available at the doorway. The CNA was also observed leaning against the mattress while providing care, and the CNA later stated that a gown was needed for the resident’s care. For another resident with MRSA infection, gastrostomy status, sepsis due to MRSA, a pressure ulcer, a central IV line, tube feeding, and an indwelling urinary catheter, the room was posted for Contact Precautions with PPE available outside the door. While the surveyor and the RD were inside the room, a phlebotomist entered with a rolling container, wore gloves but no gown or mask, and proceeded to apply a tourniquet and draw blood. When the surveyor pointed out the signage, the phlebotomist stated that the signage had not been seen. The resident records showed that both residents had orders and care plan interventions identifying transmission-based precautions, including EBP for high-contact care activities and Contact Precautions for MRSA-related care. The facility’s IP stated that staff and visitors are alerted to precautions by signage at the door and PPE at the doorway, and the DON stated that vendors are asked by staff to follow transmission-based precaution signage. A facility policy updated in February 2026 listed providing hygiene as an example of a high-contact activity requiring gown and gloves under EBP.
Ice Machine Maintenance Deficiency
Penalty
Summary
The facility failed to maintain kitchen equipment in a clean, safe, and sanitary manner, as evidenced by the presence of black sediment identified as black mold in the interior of the ice machine dispenser shoot. This was observed by a surveyor in the presence of the Food Service Director (FSD), who acknowledged the issue and stated that the ice machine was cleaned quarterly, although it appeared to require more frequent cleaning. The FSD also mentioned that the ice machine was responsible for providing ice to the food tray line and the nursing units, indicating a potential widespread impact on the facility's operations. Further interviews with the Licensed Nursing Home Administrator (LNHA) and the Director of Nursing (DON) confirmed the presence of the black sediment, with the LNHA acknowledging that the ice machine had been cleaned in early November. The facility's policy on ice machines and ice storage chests emphasized the need for regular cleaning and sanitization to prevent contamination, as outlined in the manufacturer's user manual. However, the observed black mold indicated a failure to adhere to these guidelines, resulting in unsanitary conditions within the ice machine.
Plan Of Correction
12/23/24 1. Staff responsible for maintaining the ice machine were notified of the findings and provided with immediate education. The Ice Machine dispenser shoot identified in statement of deficiencies was immediately cleaned and sanitized on 12/16/24. 2. The [R] was re-educated on how to maintain the Ice machine. The facility revised the cleaning schedule for the ice machine to monthly and as needed which includes the dispenser shoot. All residents have the potential to be affected by this deficient practice. 3. The facility will receive feedback from the Food Service Director for the next 3 months to see if there are any issues with the cleanliness of the ice machine dispenser shoot. 4. Administrator or designee will complete Ice Machine audits weekly x4 and then monthly x3. Results of these audits will be reported by the Administrator at the QAPI meetings. QAPI meetings are held Quarterly at the facility. Date of completion was 12/23/24.
Fire Alarm Box Obstruction in Kitchen
Penalty
Summary
The facility failed to ensure that each manual fire alarm box was accessible, unobstructed, and visible, as required by NFPA 101: 2012 Edition and NFPA 72: 2010 Edition. During an observation, it was noted that one of the two fire alarm pull boxes in the facility's kitchen was blocked by a freestanding steel table. This table was being used as an extension of the dishwashing machine table and had dishes and cups on it, obstructing access to the fire alarm box. This deficiency was confirmed through an interview with the Administrator in Training (AIT) at the time of the observation. The issue was brought to the attention of the facility's administration during the Life Safety Code exit conference.
Plan Of Correction
K342 1. The facility conducted a comprehensive inspection of all fire alarm pull stations to identify and ensure that all the fire alarm pull stations are accessible, unobstructed, and visible per NFPA standards. The identified area in the kitchen was repaired on 12/23/24 by Allied Fire and Safety. The maintenance director and administrator inspected the area to ensure it meets NFPA standards. 2. All maintenance personnel were educated on the importance of maintaining an accessible, unobstructed, and visible clear path in front of any fire alarm pull stations and the impact on resident safety. All residents have the potential of being affected by this. The facility will keep detailed records of fire alarm pull stations, including dates and any issues discovered. 3. The facility conducts monthly drills to ensure staff and residents are familiar with emergency procedures, which includes fire alarm pull stations. All staff at the facility are educated annually in life safety regulations, which includes maintaining an accessible, unobstructed, and visible clear path for the fire alarm pull station. 4. The facility will conduct monthly life safety audits on all fire alarm pull stations for the next 3 months to ensure the facility is in accordance with NFPA standards. The results of these audits will be communicated with the QAPI team for the next 2 quarters. Based on the results, the QAPI team will decide to conclude or continue with these audits. The QAPI team meets on a quarterly basis.
Failure to Meet Minimum Staffing Ratios
Penalty
Summary
The facility failed to maintain the required minimum direct care staff-to-resident ratios as mandated by the state of New Jersey for 4 of 14 day shifts reviewed. According to the New Jersey Department of Health memo, effective February 1, 2021, the law requires one Certified Nurse Aide (CNA) for every eight residents during the day shift. However, the facility's Nurse Staffing Reports revealed deficiencies in staffing levels on four specific days. On December 1, 2024, there were 11 CNAs for 94 residents, requiring at least 12 CNAs. On December 7 and 8, 2024, there were 10 CNAs for 92 residents, requiring at least 11 CNAs. On December 14, 2024, there were 11 CNAs for 97 residents, requiring at least 12 CNAs. During an interview on December 19, 2024, the Licensed Nursing Home Administrator (LNHA), in the presence of the Director of Nursing (DON), Infection Preventionist (IP), Regional Clinical Consultant, LNHA in training, and the survey team, acknowledged the staffing deficiencies. The LNHA stated that the facility utilizes an "alert system" to contact agency nurses to fill any call-outs when staffing is deficient. Despite this system, the facility did not meet the required staffing ratios on the specified days, leading to the identified deficiency.
Plan Of Correction
S560 Staffing 1. It is the intent of Concord Healthcare and Rehabilitation Center to maintain staffing requirement in compliance with all state and federal regulation. Efforts to hire facility staff will continue until there are adequate staff to serve all residents. Until that time, the facility will utilize staffing agencies to fill any open spots in the schedule. 2. All residents have the potential to be affected by this practice. 3. Contracts with staffing agencies have been secured to supplement facility staff. Hiring and recruitment efforts including wage analysis and adjustments, pay for experience, online job listings, job fairs, shift differentials and referral bonuses are being utilized to become more competitive in the marketplace. Wage increases for CNAs went into effect January 1st, 2025. 4. The Administrator or Designee will review staffing schedules weekly to ensure adequate staffing for all shifts. The results of these reviews will be submitted to the QAPI committee through June 2025. Based on the results of these audits, a decision will be made regarding the need for continued submission and reporting. QAPI is held on a quarterly basis.
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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 Lakewood
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Atlantic Coast Rehab & Health | 2.1 mi | ★★★★★ | 2 | 1 |
| Fountainview Care Center | 2.1 mi | ★★★★★ | 0 | 0 |
| Complete Care At Laurelton, Llc | 2.4 mi | ★★★★★ | 1 | 1 |
| Willow Springs Rehabilitation And Healthcare Ctr | 2.6 mi | ★★★★★ | 14 | 0 |
| Complete Care At Brick Llc | 2.8 mi | ★★★★★ | 14 | 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.