Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around December 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Venetian Care & Rehabilitation Center, The during CMS and state inspections, most recent first.
A facility failed to thoroughly investigate an alleged abuse incident involving a cognitively intact resident with visual and hearing impairments. The resident reported distressing care provided by a CNA, which was also described by a family member with video evidence. The facility's investigation was incomplete, lacking interviews with all relevant staff and residents, and the administrator did not review the video or collect necessary statements, contrary to facility policy.
The facility failed to identify and prevent the worsening of a contracture in a resident's right hand. Despite multiple observations and interviews, there was no documentation or care planning for the resident's condition. Staff were unaware of the contracture, and the resident did not receive any restorative care or therapy. The facility's policies on restorative nursing and comprehensive care plans were not followed.
The facility failed to maintain the required emergency water supply for its 123 residents, having only 132 gallons instead of the required 369 gallons. The FSD acknowledged the deficiency, and the LNHA confirmed the policy requirement of 1 gallon per resident per day for 3 days.
The facility failed to complete weekly skin evaluations for three residents, leading to a deficiency in pressure ulcer care and prevention. The residents, who had varying degrees of cognitive impairment and pressure ulcers, did not receive consistent evaluations as required by physician orders. The lack of documentation and adherence to protocol was confirmed through interviews with staff and review of the Electronic Medical Records (EMR) and Treatment Administration Records (TAR).
The facility failed to provide pharmaceutical services in accordance with professional standards, resulting in several deficiencies. One resident did not have their blood sugar levels documented prior to insulin administration, another resident was found with unattended medication, and the facility failed to maintain an accurate inventory of controlled medications. These oversights were confirmed by the ADON, RN/UM, and DON, highlighting a failure to adhere to physician's orders and facility policies.
The facility failed to provide adequate nail care to a resident requiring extensive assistance with ADLs. The resident had elongated, thickened, and jagged nails, and their care plan did not reflect their need for assistance with ADLs. Interviews revealed inconsistencies in nail care provision and documentation.
A facility failed to obtain and carry out an order to discontinue a Peripheral Intravenous (IV) line and to maintain the site according to professional standards of practice for a resident. The IV line was not assessed or removed in a timely manner, and the care plan did not include a focus on IV-line care or IV antibiotics. The facility's policy on catheter insertion and care was not followed, and the IV line was not removed until after the surveyor's inquiry.
The facility failed to ensure safe and appetizing food temperatures for residents, as identified during a Resident Council meeting and confirmed during a lunchtime meal service. Food temperatures on the 2nd floor unit were significantly below the required levels for hot foods and above the required levels for cold foods. The Food Service Director confirmed that temperatures were taken in the kitchen but not recorded once the food was on the truck.
The facility failed to provide meals according to physician's orders and resident preferences for two residents. One resident did not receive prescribed fortified foods and a low-sugar shake, while another did not receive the correct portions of protein, whole milk, or specified beverages. Staff acknowledged the discrepancies and lack of accountability for tray accuracy.
Failure to Thoroughly Investigate Alleged Abuse Incident
Penalty
Summary
A deficiency occurred when the facility failed to thoroughly investigate an allegation of abuse involving a resident with visual and hearing impairments, who was cognitively intact and required supervision or touch assistance with activities of daily living. The resident reported that an unknown individual entered their room after supper, pulled down their pants, cleaned them, put a diaper on them despite not wearing diapers, and attempted to put a hospital gown on them. The resident became distressed and the individual eventually put their clothes back on. The resident informed a family member, who had video evidence of the incident and described that a CNA entered the room, attempted to change the resident, and was told by another aide that such care was not needed for this resident, who was independent. The facility's investigation was incomplete. The administrator did not collect statements from all staff present at the time of the incident, nor from other alert and oriented residents assigned to the staff member involved. The administrator also did not review the video recording provided by the family. The LPN who was present during the incident and the LPN/Infection Control Nurse who reviewed the video and performed a skin assessment were not asked to provide written statements. The CNA involved was not reached for an interview, and no documentation was provided regarding their account of the incident. Facility policy requires that all allegations of abuse be thoroughly investigated, including reviewing documentation and evidence, interviewing all relevant staff and residents, and documenting the investigation completely. The investigation conducted did not meet these requirements, as key interviews and evidence review were omitted, and the findings were not fully documented as per policy.
Failure to Address Resident's Contracture
Penalty
Summary
The facility failed to identify and prevent the worsening of a contracture in a resident's right hand. The resident, who was observed multiple times by the surveyor, had a contracture in the right hand with no brace or any intervention in place. The resident reported being unable to use the right hand and stated that the staff did not provide any support or items to help manage the contracture. The resident's medical records did not include any documentation or care planning for the upper extremity impairment or contracture, despite the resident being cognitively intact and able to communicate their needs and condition. Interviews with the facility staff, including CNAs, the Unit Manager, and the Occupational Therapist, revealed a lack of awareness and action regarding the resident's contracture. The CNAs mentioned that they would perform range of motion exercises and inform the nurse if they noticed a contracture, but there was no evidence of such actions being taken for this resident. The Unit Manager and Occupational Therapist were unaware of the contracture and did not have the resident on a restorative program or therapy for the condition. The facility's policies on restorative nursing and comprehensive care plans were not followed, as there was no documentation or intervention for the resident's contracture. The facility's failure to address the resident's contracture was further evidenced by the lack of physician's orders for a splint or brace and the absence of any restorative care for range of motion exercises in the resident's treatment records. The Director of Rehabilitation confirmed that the resident had not received therapy services and that staff should make referrals to therapy if they identified any decline in function or limitations with activities of daily living. The facility's documentation and care planning deficiencies were acknowledged by the Licensed Nursing Home Administrator, who provided a timeline and other documentation that did not include any interventions for the resident's contracture.
Failure to Maintain Adequate Emergency Water Supply
Penalty
Summary
The facility failed to maintain the designated emergency supply of water needed for residents in the event of a loss of normal water supply. During a survey, it was observed that the facility, which had a census of 123 residents, only had 132 gallons of emergency water available, whereas the requirement was 369 gallons (1 gallon per resident per day for 3 days). The Food Service Director (FSD) acknowledged the deficiency and mentioned that some water had been discarded due to expiration, and an order had been placed to replenish the supply. However, the provided invoices did not show that water had been ordered prior to the surveyor's inquiry. The Licensed Nursing Home Administrator (LNHA) and the FSD confirmed that the facility's policy required maintaining a 3-day emergency water supply based on the current census. The LNHA stated that the responsibility for ensuring the emergency supply was sufficient lay with the FSD, and there was no delay in approval or delivery of the order. Despite this, the surveyor found that the facility did not have the required amount of emergency water at the time of the survey, and the FSD admitted that the emergency water supply was insufficient based on the resident census.
Failure to Complete Weekly Skin Evaluations
Penalty
Summary
The facility failed to complete weekly skin evaluations for three residents, leading to a deficiency in pressure ulcer care and prevention. Resident #5, who was moderately cognitively impaired and had a Stage 3 pressure ulcer, did not have consistent weekly skin evaluations documented in the Electronic Medical Record (EMR) as required by the physician's order. The Treatment Administration Record (TAR) showed several instances where the evaluations were not completed, and the Licensed Practical Nurse (LPN) and Unit Manager (UM) confirmed the lack of documentation and adherence to the protocol during interviews with the surveyor. Resident #49, who was severely cognitively impaired and had a Stage 4 pressure ulcer, also did not receive the mandated weekly skin evaluations. The TAR indicated missed evaluations, and the EMR lacked documentation of these assessments. The LPN/UM verified the deficiency, acknowledging that the only documented skin assessment was from February, despite the requirement for weekly evaluations. The resident's care plan highlighted the high risk for pressure ulcers, yet the facility failed to follow through with the necessary preventive measures. Resident #86, who had a history of pneumonia and dysphagia and was severely cognitively impaired, similarly did not receive consistent weekly skin evaluations. The TAR showed missed evaluations, and the EMR had incomplete documentation of the required assessments. Interviews with the CNA, Desk Nurse/Registered Nurse (DN/RN), and Assistant Director of Nursing (ADON) confirmed the lapses in protocol. The Regional Clinical Operations/Registered Nurse (RCO/RN) reviewed the records and verified the deficiencies, emphasizing the importance of weekly skin assessments to monitor and prevent skin abnormalities.
Failure to Provide Pharmaceutical Services and Medication Management
Penalty
Summary
The facility failed to provide pharmaceutical services in accordance with professional standards, resulting in several deficiencies. One resident, who was prescribed insulin Glargine with specific parameters to hold the medication if blood sugar was less than 100, did not have their blood sugar levels documented prior to administration. This oversight was confirmed by the Assisted Director of Nursing (ADON) and the Registered Nurse/Unit Manager (RN/UM), who acknowledged that the blood sugars were not documented on the electronic Medication Administration Record (eMAR) as required. The resident had a history of diabetes mellitus type 2, cerebral infarction, and occlusion and stenosis of the left carotid artery, and their cognition was intact as indicated by a Brief Interview for Mental Status (BIMS) score of 13 out of 15. Despite the physician's order, the facility failed to ensure proper monitoring and documentation of blood sugar levels before administering insulin, which is crucial for preventing hypoglycemia. The ADON and RN/UM both confirmed the lack of documentation and the importance of following the parameters set by the physician's order. Another deficiency was observed when a resident was found with a medication cup containing four tablets on their overbed table. The RN/UM, who was responsible for administering the medication, could not explain how the medication ended up on the table and acknowledged that it was the nurse's responsibility to ensure that the medication was not left unattended and that the resident consumed all their medications. The resident had a history of heart failure, acute pulmonary edema, adjustment disorder with depression, and hypertension, and their cognition was moderately impaired with a BIMS score of 8 out of 15. The medications found included a multivitamin with minerals, Coreg, Eliquis, and Lasix, all of which were signed off as administered on the eMAR. The Director of Nursing (DON) confirmed that medications should never be left unattended and that the nurse should ensure the resident consumes their medication. The facility also failed to maintain an accurate inventory of controlled medications dispensed from the automated medication dispensing system (AMDS) on the 2nd floor nursing unit. The surveyor found that the daily count narcotic back-up sheets were not consistently maintained, with the DON only able to provide records for two days in March. The DON acknowledged the importance of daily inventory counts for controlled substances to ensure accountability and prevent medication diversion. The facility had recently created a new form for daily counts of narcotics and controlled substances, but the lack of consistent documentation prior to this change indicated a failure to adhere to their own policies and procedures for controlled substances and the AMDS system.
Failure to Provide Adequate Nail Care
Penalty
Summary
The facility failed to provide adequate nail care to a resident who required extensive assistance with Activities of Daily Living (ADL). During an initial tour, a surveyor observed the resident with elongated, thickened, and jagged nails, indicating a lack of proper nail care. The resident's medical records showed that they had significant impairments, including cerebrovascular disease, a right leg above-knee amputation, and atherosclerotic heart disease. The resident was cognitively intact but required extensive assistance for most ADLs and personal hygiene. Despite this, the resident's care plan did not reflect their need for assistance with ADLs, including nail care. Interviews with CNAs and the Unit Manager revealed inconsistencies in the provision and documentation of nail care, with no log maintained for such care. The resident expressed dissatisfaction with the length of their nails and confirmed that staff did not clean their nails during care. The Unit Manager acknowledged the importance of nail care to prevent infection and other issues but admitted that the resident's nails were long and needed trimming. The facility's policies on ADL care and comprehensive care planning were reviewed, showing that the care plan should include the level of assistance needed for ADLs and be culturally competent and trauma-informed. However, these policies were not adequately followed in the case of this resident, leading to the identified deficiency.
Failure to Discontinue and Maintain IV Line
Penalty
Summary
The facility failed to obtain and carry out an order to discontinue a Peripheral Intravenous (IV) line and to maintain the site according to professional standards of practice for a resident. The resident was admitted with an IV access site and had completed a course of IV antibiotics. However, there was no physician order to maintain or discontinue the IV line after the completion of the antibiotics, and the IV line was not assessed or removed in a timely manner. The IV line was observed to be covered by a transparent dressing with peeling tape and was not dated or initialed, indicating a lack of proper maintenance and documentation. The resident's care plan did not include a focus on IV-line care or IV antibiotics, and the staff failed to document the kind of access the resident had and when it was inserted upon admission. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) acknowledged that the IV line should have been removed after the completion of the antibiotics and that the care plan should have been initiated for IV line care. The facility's policy on catheter insertion and care was not followed, as the IV dressing was not changed as needed to prevent catheter-related infections. Interviews with the resident's Registered Nurse (RN), Charge Nurse (RN/CN), MDS coordinator, and DON revealed a lack of awareness and proper documentation regarding the IV line. The RN/CN and surveyor confirmed the presence of the IV line, and the RN/CN acknowledged that it was unacceptable for the IV line to still be in place. The DON provided a timeline indicating that the IV line was not removed until after the surveyor's inquiry, despite recommendations from the Infectious Disease physician to discontinue the IV line earlier.
Failure to Maintain Safe and Appetizing Food Temperatures
Penalty
Summary
The facility failed to ensure the safe and appetizing temperatures of foods served to the residents. This deficiency was identified during a Resident Council meeting where five residents unanimously agreed that their food trays were not warm. Further investigation during the lunchtime meal service on the 2nd floor unit revealed that the food temperatures were significantly below the required levels. For instance, the roast beef was at 122.5 degrees F, roasted potatoes at 121.0 degrees F, and the Capri vegetable blend at 115.9 degrees F, all of which are below the acceptable hot food temperature. The cold items, such as the fruit cup and milk, were also above the required cold food temperature, with the fruit cup at 53.3 degrees F and the milk at 54.3 degrees F. The Food Service Director (FSD) confirmed that the food temperatures were taken in the kitchen before the trays were dispatched, and the temperatures were within the acceptable range at that time. However, the FSD admitted that he does not record the temperatures of the food once it has been on the truck for a while. The facility's policies on hot and cold food temperatures were reviewed, revealing that the kitchen is responsible for ensuring that hot foods are served at safe temperatures and cold foods at 41 degrees F or lower. Despite these policies, the facility failed to maintain the appropriate food temperatures during the delivery process, leading to the deficiency.
Failure to Provide Meals According to Physician's Orders and Resident Preferences
Penalty
Summary
The facility failed to ensure foods were provided in accordance with physician's orders and resident preferences as identified in their plan of care. This deficiency was observed in two residents. For Resident #114, the surveyor noted discrepancies in the meal tray items on multiple occasions. The resident, who had severe cognitive impairment and diagnoses including Alzheimer's Disease and cachexia, did not receive the prescribed fortified mashed potatoes, low-sugar house shake, and was given chocolate ice cream instead of vanilla. The LPN/UM, RD, and FSD all acknowledged the missing items, and the FSD admitted that the facility was out of low-sugar health shakes. The RRD confirmed that the missing items were part of the resident's plan of care to promote weight gain, and there was no clear accountability for ensuring tray accuracy in the kitchen. For Resident #120, the surveyor observed that the resident's lunch tray did not match the meal ticket. The resident, who had intact cognition and diagnoses including type 2 diabetes and Parkinson's Disease, did not receive the correct portions of protein, whole milk, or the specified beverages. The FSD and RRD both acknowledged the discrepancies and stated that the meal ticket should have been followed. The FSD admitted that the facility was out of whole milk and that no one was assigned to check the trays for accuracy on the day of the observation. The LNHA acknowledged the concerns regarding tray accuracy but provided no additional information. The facility's policies on Medical Nutrition Therapy Documentation, Therapeutic Diets, Fortified Foods and Supplements, Dining and Food Preferences, and Tray Accuracy were reviewed. These policies outlined the responsibilities of the RD, FSD, and other dietary staff to ensure that residents received meals according to their diet orders and preferences. However, the observations and interviews indicated that these policies were not followed, leading to the deficiencies noted in the report.
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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 South Amboy
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Alameda Center For Rehabilitation And Healthcare | 2.1 mi | — | 1 | 0 |
| Spring Creek Healthcare Center | 3.8 mi | — | 0 | 0 |
| Complete Care At Madison, Llc | 4.5 mi | — | 14 | 0 |
| St Joseph's Home Al & Nc, Inc | 5.5 mi | — | 0 | 0 |
| Meadowbrook Respiratory And Nursing Center | 5.8 mi | — | 0 | 0 |
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