Provider Name: CLOVER REST HOME
Address: 28 WASHINGTON STREET, COLUMBIA, NJ 07832
Phone: (908) 496-4477
County: Warren (390)
Ownership Type: For profit - Limited Liability company
Certified Beds: 33
Average Residents Per Day: 29.9 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: LIGHTHOUSE CLOVER, LLC
First Approved Date: August 29, 1997
Affiliated Entity: ()
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 2 ()
Health Inspection Rating: 3 ()
QM Rating: 2 ()
Long Stay QM Rating: 2 ()
Short Stay QM Rating: 2 ()
Staffing Rating: 1 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.24467, LPN Staff Hours Per Day: 1.3172, RN Staff Hours Per Day: 0.4107, Licensed Staff Hours Per Day: 1.7279
Total Nurse Staff Hours Per Day, per resident: 3.97259
Weekend Nurse Staff Hours: 3.43017, Weekend RN Staff Hours: 0.4030
PT Staff Hours Per Day, per resident: 0.2024
Nurse Staff Turnover: , Nurse Turnover Note: 6
RN Turnover: , RN Turnover Note: 6
Admin Left Number: , Admin Turnover Note: 6
Case Mix Nurse Aide Hours Per Day, per resident: 2.0752, Case Mix LPN Hours Per Day: 0.8008, Case Mix RN Hours Per Day: 0.5981
Adjusted Nurse Aide Hours Per Day, per resident: 2.20357, Adjusted LPN Hours Per Day: 1.2138, Adjusted RN Hours Per Day: 0.2587
Total Adjusted Nurse Hours Per Day, per resident: 3.60418
Adjusted Weekend Nurse Hours Per Day, per resident: 3.11207
Health Survey Dates and Scores: Cycle 1: 2021-10-22 (Score: 8), Cycle 2: 2019-11-27 (Score: 4), Cycle 3: 2019-01-24 (Score: 100)
Total Weighted Health Score: 22.000
Reported Incidents: 0, Substantiated Complaints: 5
Infection Control Citations: 0
Fines and Penalties: Number of Fines: 2, Total Fines in Dollars: 52897.80, Payment Denials Number: 0, Total Penalties Number: 2
Location and GPS: 28 WASHINGTON STREET,COLUMBIA,NJ,07832 (40.9252, -75.094)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-11-22
Type: Health, Deficiency: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-11-22
Type: Health, Deficiency: Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Severity: B - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Waiver has been granted on 2021-11-15
Type: Health, Deficiency: Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-03-24
Type: Health, Deficiency: Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Severity: B - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Waiver has been granted on 2020-08-24
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: K - Level 4: Immediate jeopardy to resident health or safety. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-03-10
Type: Health, Deficiency: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Severity: B - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-02-28
Type: Health, Deficiency: Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Severity: B - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Waiver has been granted on 2019-02-28
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications: