Average — CMS composite of the measures below.
A standard survey is most likely before around December 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at New Jersey Veterans Memorial Vineland during CMS and state inspections, most recent first.
A resident with severe cognitive impairment and a feeding tube received 800 ml of enteral feeding over four hours instead of the physician-ordered 60 ml/hr due to an LPN's failure to properly set up and monitor the feeding pump. The tube feeding was administered by gravity rather than through the pump, and the error was not promptly identified. The resident developed respiratory distress, was hospitalized with aspiration pneumonia, and subsequently expired.
A nurse failed to wear the required PPE, specifically a gown, while providing tube feeding care to a resident on Enhanced Barrier Precautions, despite facility policy and clear signage. The resident had significant medical needs, including a feeding tube and impaired cognitive function. The CNA followed proper protocol, but the RN did not, resulting in noncompliance with infection prevention procedures.
Surveyors identified multiple deficiencies in food handling and sanitation practices at the facility. Dented cans, uncovered food items, and undated jars were found in storage areas. Equipment like can openers and deli slicers were not cleaned properly. A staff member was observed with hair protruding from their hairnet, and nourishment rooms had undated juice bottles. These issues indicate non-compliance with the facility's policies on food safety and sanitation.
A resident with severe cognitive impairment was involved in an altercation resulting in a skin tear, requiring wound treatment and antibiotics. Despite physician orders, the facility failed to update the care plan to include these interventions, revealing a communication breakdown among staff.
Improper Tube Feeding Administration Resulting in Resident Harm
Penalty
Summary
A deficiency occurred when a severely cognitively impaired resident, who was dependent on staff for all activities of daily living and had a feeding tube due to NPO status and dysphagia, received improper administration of tube feeding. The physician's order specified that the resident was to receive enteral feeding at a rate of 60 ml per hour, but instead, the resident received 800 ml of tube feeding over four hours. This was due to the failure of an LPN to properly set up and monitor the feeding pump, resulting in the tube feeding being administered by gravity rather than through the pump at the prescribed rate. The facility's policy required that all tube feedings be administered by a registered nurse or LPN in accordance with specific procedures, including verifying the physician's order, ensuring the tube is secure, setting the pump to the correct rate, and monitoring the pump's function. However, the LPN did not thread the feeding tube through the pump and did not monitor the feeding pump to ensure it was functioning properly. As a result, the resident received a large volume of feeding in a short period, which was not in accordance with the physician's order. Staff interviews and documentation revealed that the error was not promptly identified. The resident was found with symptoms of respiratory distress and a critically low oxygen saturation level. The resident was subsequently sent to the hospital, where they were diagnosed with aspiration pneumonia and later expired. The facility's failure to follow its tube feeding policy and to monitor the resident appropriately led to this outcome.
Failure to Follow Enhanced Barrier Precautions During Tube Feeding Care
Penalty
Summary
A deficiency was identified when a Registered Nurse (RN) failed to wear the required Personal Protective Equipment (PPE), specifically a gown, while providing care to a resident on Enhanced Barrier Precautions (EBP). The RN entered the resident's room to flush and disconnect a feeding tube without donning a gown, despite facility policy and CDC guidance requiring gown and gloves for high-contact care activities such as tube feeding. The Certified Nursing Assistant (CNA) was observed entering the same room with the appropriate PPE, and both staff members confirmed the resident was on EBP due to the presence of a feeding tube. The resident involved had a history of cerebral infarction, aphasia, and dysphagia, and was assessed as having severely impaired cognitive skills. Facility documentation, including the resident's Plan of Care and the policy on Enhanced Barrier Precautions, specified the need for PPE during high-contact care. The RN acknowledged not following the protocol, while the CNA demonstrated compliance. The facility's policy outlined the importance of PPE use to prevent the spread of multidrug-resistant organisms, but this protocol was not consistently followed during the observed care.
Deficiencies in Food Handling and Sanitation Practices
Penalty
Summary
The facility was found to have several deficiencies in food handling and sanitation practices during a survey. In the dry storage area, dented cans of tomato puree and pineapple juice were found on the shelf, despite the expectation that staff should identify and remove such items. Additionally, an opened box of Styrofoam bowls was left uncovered, and a can opener with debris on its blade was found in the bread storage area. An opened bag of dinner rolls was also exposed to air, and a jar of lite salad dressing in the walk-in refrigerator was undated. Furthermore, the reach-in ice cream freezer lacked an internal thermometer and temperature log sheet, and a bag of ribs in the walk-in refrigerator was improperly covered. In the food prep area, there was debris under the sink, and an uncovered stand mixer and deli slicer were found with debris on them. The deli slicer was not cleaned after use, contrary to the facility's policy. During the lunch tray meal line, a Senior Food Service Handler was observed with hair protruding from their hairnet, which was not in compliance with the facility's infection control policy. In the unit nourishment rooms, undated opened bottles of cranberry juice and orange juice with printed dates assumed to be expiration dates were found, indicating a lack of proper labeling and stock rotation. The facility's policies on handling damaged food products, infection control, storage, and cleaning and sanitizing equipment were not adhered to, as evidenced by the observations made during the survey. The facility's checklist for kitchen sanitation and the nourishment room maintenance policy were also not followed, leading to the deficiencies identified by the surveyors.
Failure to Update Care Plan After Resident Altercation
Penalty
Summary
The facility failed to develop a comprehensive, person-centered care plan for a resident who sustained a skin tear following a resident-to-resident altercation. The resident, who was severely cognitively impaired with diagnoses including unspecified dementia and PTSD, was involved in an incident where they were bitten on the right arm by another resident. This resulted in a skin tear that required wound treatment and an oral antibiotic, as prescribed by a physician. Despite the physician's orders for wound treatment and antibiotic administration, the facility did not update the resident's care plan to reflect these interventions. The care plan lacked documentation of the skin tear and the prescribed treatments, which were administered as ordered. Interviews with facility staff, including the Assistant Director of Nursing, Director of Nursing, and Registered Nurse Assessment Coordinator (RNAC), revealed a lack of communication and understanding regarding the necessity of updating the care plan with new interventions following the incident. The facility's policy required that care plans describe the services furnished to maintain the resident's well-being and be evaluated and modified as necessary. However, the RNAC and other staff members did not ensure that the care plan was updated to include the wound treatment and antibiotic prescribed for the resident's injury. The Chief Executive Officer acknowledged a communication breakdown that led to the omission of these critical updates in the care plan.
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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 Vineland
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Bishop Mccarthy Center For Rehab & Healthcare | 1.5 mi | ★★★★★ | 0 | 0 |
| Autumn Lake Healthcare At Vineland | 3.4 mi | ★★★★★ | 0 | 0 |
| Big Oak Rehabilitation And Healthcare Center | 5.2 mi | ★★★★★ | 8 | 0 |
| Millville Center | 5.9 mi | ★★★★★ | 2 | 2 |
| South Jersey Extended Care | 11.3 mi | ★★★★★ | 16 | 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 August 2026) and official state health department websites.