Above average — CMS composite of the measures below.
The next survey window likely opens around February 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 Heath Village during CMS and state inspections, most recent first.
Call devices were left out of reach for two residents who were observed in bed with their call bells hanging down to the floor. One resident had moderately impaired cognition, and both residents had care plans that included placing the call bell within reach due to fall risk factors. A CNA acknowledged a broken clip on one resident's call device, and the DON stated the call bell must be within reach.
A resident with depression, anxiety, mood disorder, and dementia had a care plan that focused on Zoloft for depression but did not include Seroquel and Trazodone, despite the resident receiving psychotropic medications and the MDS showing antipsychotic use. The LPN stated these medications should have been included in the CP to reflect care and monitor side effects, while the LPN/UM said all nurses were responsible for CP documentation and did not explain why the medications were omitted.
A resident with osteoporosis and chronic pain fell in the facility, but a CNA did not report the fall to the nurse and instead helped the resident back into a chair; the event was not documented until later. In a separate incident, another high-fall-risk resident had an order for floor mats on both sides of the bed, but one mat was left against the wall because a CNA accommodated the resident’s tray table request and did not notify the nurse.
Incorrect Oxygen Flow Rate: A resident receiving oxygen for SOB related to an MI was observed multiple times with the flow meter set below the ordered rate. The resident’s order called for oxygen at 2 L/min continuously, but the flow meter was found at 1.5 L/min, and the RN supervisor confirmed it was set incorrectly. Facility policy required oxygen to be administered and maintained per MD order.
Illegible physician progress notes were found for a resident with unspecified dementia, mood disturbance, and severe cognitive impairment based on a BIMS score of 6/15. Surveyors observed handwritten MD notes in the hybrid chart that were difficult to read, and an LPN and LPN UM both stated they could only read some of the notes and would need clarification from another nurse or the physician. The DON agreed the notes were difficult to read, and the facility policy reviewed did not address note legibility.
Blocked access to hallway handrails was identified when surveyors observed the Juniper Way wing handrails by the exit/egress doors to the public way obstructed by a long 2-shelf furniture unit about 5 feet wide. The LSD, APOD, and POD confirmed the observation, and the issue involved 1 of 8 areas observed with potential impact to all residents.
An LPN at a facility failed to administer Fluticasone nasal spray according to the manufacturer's instructions, as observed during a medication pass. The LPN did not instruct a resident to blow their nose before administration, and the manufacturer's package insert was missing. The RN/UM confirmed the oversight, and the issue was discussed with the facility's management team.
A resident with a stage 3 pressure ulcer received wound care that did not adhere to infection control standards. The LPN placed supplies on an unclean surface, failed to change gloves after disinfecting the overbed table and handling the trash can, and did not clean scissors before and after use. These actions were observed and confirmed by the staff involved.
Call Devices Left Out of Residents' Reach
Penalty
Summary
The facility failed to ensure that residents' call devices were readily accessible for 2 of 21 residents reviewed for reasonable accommodations of needs and preferences. Resident #14 was observed in bed on multiple occasions with the call device hanging down to the floor and out of reach. When interviewed, the resident said they did not see where the call bell was and asked what they would do if they needed to call someone. A CNA later acknowledged that the call bell should be accessible and stated that the clip on the resident's call device was broken. Resident #14's admission MDS showed a BIMS score of 9 out of 15, indicating moderately impaired cognition, and the care plan identified the resident as at risk for falls related to impaired mobility after hospitalization for fall, psychoactive medications, and impaired cognition, with interventions including placing the call bell within reach and encouraging the resident to call for assistance. Resident #9 was also observed in bed with the call device hanging down to the floor and out of reach on two separate observations. The resident's care plan identified risk for falls related to balance problems, confusion, poor safety awareness, and unsteady gait, with interventions including placing the call bell within reach and encouraging the resident to call for assistance. During discussion with the LNHA and DON, the DON stated that the call bell must be placed within reach of the resident. The facility's Nurse Call System Policy and Procedures did not address the positioning of the call bell.
Care Plan Not Updated for Psychotropic Medications
Penalty
Summary
The facility failed to revise the care plan for one resident reviewed for a comprehensive care plan. Resident #49 was observed in bed, awake, watching TV, and able to answer questions, and stated they had no concerns with the facility. The resident’s record showed diagnoses including depression, anxiety, mood disorder, and dementia, and the quarterly MDS dated 2/27/26 indicated a BIMS score of 14 out of 15, reflecting intact cognition. The MDS also showed the resident was taking antipsychotic medications. Record review showed an order for Seroquel 25 mg by mouth at bedtime for depression related to other specified mood disorders, and the care plan initiated on 11/22/25 focused on Zoloft for depression. The surveyor noted that psychotropic medications, including Seroquel and Trazodone, should have been included in the care plan because they were part of the resident’s care and used to monitor medication side effects. The LPN/UM stated that all nurses were responsible for documenting the care plan and did not provide an explanation for why Seroquel and Trazodone were not included. The LPN/UM updated the care plan after the surveyor’s inquiry. The facility policy stated that care plans must be accurate, current, and individualized.
Failure to Report a Fall and Follow Ordered Fall-Prevention Measures
Penalty
Summary
The facility failed to report and immediately investigate a fall for a cognitively intact resident with diagnoses including low back pain, age-related osteoporosis, and chronic pain syndrome. The resident stated that they had fallen in the facility twice with no injuries and that staff had educated them to call for assistance. The fall investigation showed that a CNA found the resident on the floor in front of a recliner during rounds at 5:00 AM, but the CNA did not report the fall to the nurse, assisted the resident back into the chair, and told the resident to call for help. The nurse did not learn of the event until morning medication pass, and the electronic record contained no progress note documenting the fall at the time it occurred. The facility also failed to consistently implement ordered fall-prevention interventions for a resident with difficulty walking, muscle weakness, and need for care following digestive system surgery. The resident had a Morse Fall Scale score of 80, indicating high fall risk, and the physician ordered floor mats on both sides of the bed with placement to be checked every shift. The care plan also included mats on the floor when the resident was in bed. During survey observations, one mat was in place on the left side of the bed while the right-side mat was leaning against the wall. When interviewed, the CNA assigned to the resident stated the right-side mat was left against the wall because the resident wanted the tray table next to the bed, and the CNA did not report the issue to the nurse. The supervising LPN confirmed the mats should have been in place as ordered and stated she had not been informed of the problem. The LPN also confirmed that overbed tables can be positioned safely on top of the floor mats.
Incorrect Oxygen Flow Rate
Penalty
Summary
The facility failed to provide ordered respiratory care consistent with professional standards of practice for one resident who was receiving oxygen via nasal cannula for shortness of breath related to a prior myocardial infarction. The resident had an order for oxygen at 2 L/min continuously every shift, and the care plan identified ineffective gas exchange with oxygen therapy as an intervention. During three separate observations, the surveyor found the oxygen flow meter set at 1.5 L/min while the resident was lying in bed receiving oxygen via nasal cannula. The March 2026 MAR showed nurses documented oxygen use every shift on 3/18/26 and on the day and evening shifts of 3/19/26. When the RN Supervisor was asked to verify the oxygen setting, the supervisor confirmed the flow meter was set at 1.5 L/min, acknowledged it was incorrect, and adjusted it to 2 L/min per the physician’s order. The facility’s oxygen policy and procedure stated that oxygen must be administered and maintained according to physician orders and that staff must ensure the flow rate is set at the ordered level.
Illegible Physician Progress Notes
Penalty
Summary
The physician's progress notes for one resident were not legible. The resident had diagnoses that included unspecified dementia and mood disturbance, and the quarterly MDS dated 12/19/25 indicated a BIMS score of 6 out of 15, showing severe cognitive impairment. During observation and record review, the surveyor found handwritten physician notes in the hybrid medical record that could not be read clearly. The surveyor showed the handwritten progress notes dated 12/29/25, 1/27/26, and 2/27/26 to an LPN, who stated she had difficulty reading the doctor's notes and would ask another nurse or the LPN UM to read them, or call the physician for clarification if needed. The LPN UM also stated that she could read some of the notes but not all of them. When the survey team met with the Administrator, DON, and Nursing Supervisor, the DON agreed that it was difficult to read the notes. The facility policy reviewed did not address the legibility of doctors' notes.
Blocked Access to Hallway Handrails
Penalty
Summary
The facility failed to ensure that wooden handrails were installed, maintained, secured, and splinter free in all required locations. During an observation with the Life Safety Director, Assistant Plant Operations Director, and Plant Operations Director, the Juniper Way wing handrails by the exit/egress doors to the public way were found blocked from access by a long 2-shelf furniture unit approximately 5 feet wide. In interview, the Life Safety Director, Assistant Plant Operations Director, and Plant Operations Director all confirmed the observation. The deficient practice was identified in 1 of 8 areas observed and was noted as having the potential to affect all residents.
Improper Administration of Fluticasone Nasal Spray
Penalty
Summary
The facility failed to ensure the proper administration of Fluticasone nasal spray in accordance with the manufacturer's specifications and professional standards of practice. During a medication pass observation, an LPN administered Fluticasone to a resident without instructing them to blow their nose prior to administration, as required by the manufacturer's instructions. The LPN was observed preparing the medication and administering it to the resident without following the necessary steps to ensure the medication's effectiveness. The manufacturer's package insert, which should have been available with the medication, was missing, and the electronic Medication Administration Record did not include the necessary ancillary instructions. The LPN acknowledged the oversight and mentioned that she could look up the information if needed. The RN/UM confirmed that the manufacturer's package insert should have been with the medication and that the LPN should have instructed the resident to blow their nose before administration. This deficiency was discussed with the facility's management team, including the DON, IP, ADON, and LNHA.
Infection Control Lapses During Wound Care
Penalty
Summary
The facility failed to maintain infection control standards during wound care treatment for a resident with a stage 3 pressure ulcer. The resident, who was admitted with diagnoses including diabetes mellitus, neoplasm of the rectum, and a gastrostomy status, was observed receiving wound care that did not adhere to proper infection control protocols. The resident's medical record indicated a moderate cognitive impairment and the presence of two stage 3 pressure ulcers upon admission. During the wound care treatment, the LPN and RN involved did not follow proper procedures. The LPN placed treatment supplies on an unclean surface and failed to change gloves after disinfecting the overbed table and handling the trash can. Additionally, the LPN did not clean the scissors before and after use, which is against the facility's policy. These actions were observed by the surveyor and confirmed by the LPN and RN during an interview. The Director of Nursing and the Licensed Nursing Home Administrator were informed of the observations. The facility's undated Wound Care Competency guidelines were reviewed, which included the requirement for hand hygiene before setting up a clean field. The DON confirmed the lapses in procedure, acknowledging that the supplies should not have been placed on an unclean surface, gloves should have been changed after certain tasks, and scissors should have been disinfected before and after use.
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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 Hackettstown
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Little Brook Nursing And Convalescent Home | 6.6 mi | ★★★★★ | 0 | 0 |
| Warren Haven Rehab And Nursing Center | 7.6 mi | ★★★★★ | 1 | 0 |
| Forest Manor Hcc | 8.6 mi | ★★★★★ | 0 | 0 |
| Merry Heart Nursing Home | 9.2 mi | ★★★★★ | 0 | 0 |
| Holly Manor Center | 12.7 mi | ★★★★★ | 0 | 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.