Cycle 1
Health 2024-07-09 · Fire 2024-07-09
21 health deficiencies
Top issue: Resident Assessment and Care Planning (4 deficiencies)
5 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Cedar Grove, NJ
Alaris Health At Cedar Grove
2-star overall rating with 1-star inspections with 21 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
110 Grove Ave, Cedar Grove, NJ
(973) 571-6600
Overall
2 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
230
Certified beds
Average residents
162
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Alaris Health
Operator or chain grouping
Approved since
1996-11-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
7 facilities
Chain averages 3 overall / 3 health / 4 staffing / 4 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.95
Registered nurse staffing · state 0.69 · national 0.68
LPN hours / resident day
0.71
Licensed practical nurse staffing · state 0.94 · national 0.87
Aide hours / resident day
3.04
Nurse aide staffing · state 2.23 · national 2.35
Total nurse hours
4.70
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.66
RN + LPN hours · state 1.62 · national 1.54
Weekend hours
4.25
Weekend nurse staffing · state 3.45 · national 3.43
Weekend RN hours
0.70
Weekend registered nurse coverage · state 0.49 · national 0.47
Physical therapist
0.09
Reported PT staffing · state 0.11 · national 0.07
Adjusted RN hours
1.13
CMS adjusted RN staffing hours
Adjusted total hours
5.56
CMS adjusted total nurse staffing hours
Case-mix index
1.16
Higher values indicate more complex resident acuity
RN turnover
36%
Annual RN turnover · state 39% · national 45%
Total nurse turnover
43%
Annual nurse turnover · state 41% · national 46%
SNF VBP
Value-based purchasing
Program rank
2,171
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
51.28
Composite VBP score used to determine payment impact.
Payment multiplier
1.0056
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.93
Baseline 19.53% · Performance 18.22% · Measure score 6.93 · Achievement 6.93 · Improvement 4.73
Healthcare-associated infections
0
Baseline 8.14% · Performance 8.79% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
3.58
Baseline 42.37% · Performance 49.03% · Measure score 3.58 · Achievement 3.58 · Improvement 0
Adjusted total nurse staffing
10
Baseline 4.55 hours · Performance 5.80 hours · Measure score 10 · Achievement 10 · Improvement 9
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.64% |
10.72%
0.1 pts better
|
No Different than the National Rate · Eligible stays 258 · Observed rate 10.85% · Lower 95% interval 8.5% |
| Discharge to community | 58.13% |
50.57%
7.6 pts better
|
Better than the National Rate · Eligible stays 225 · Observed rate 51.11% · Lower 95% interval 50.65% |
| Medicare spending per beneficiary | 1.09 |
1.02
0.1 pts worse
|
|
| Drug regimen review with follow-up | 89.71% |
95.27%
5.6 pts worse
|
Numerator 157 · Denominator 175 |
| Falls with major injury | 0.57% |
0.77%
0.2 pts better
|
Numerator 1 · Denominator 175 |
| Discharge self-care score | 61.61% |
53.69%
7.9 pts better
|
Numerator 69 · Denominator 112 |
| Discharge mobility score | 71.43% |
50.94%
20.5 pts better
|
Numerator 80 · Denominator 112 |
| Pressure ulcers or injuries, new or worsened | 2.29% |
2.29%
About the same
|
Numerator 4 · Denominator 175 · Adjusted rate 1.96% |
| Healthcare-associated infections requiring hospitalization | 8.79% |
7.12%
1.7 pts worse
|
No Different than the National Rate · Eligible stays 136 · Observed rate 10.29% · Lower 95% interval 5.47% |
| Staff COVID-19 vaccination coverage | 1.48% |
8.2%
6.7 pts worse
|
Numerator 3 · Denominator 203 |
| Staff flu vaccination coverage | 85.94% |
42%
43.9 pts better
|
Numerator 165 · Denominator 192 |
| Discharge function score | 71.43% |
56.45%
15 pts better
|
Numerator 80 · Denominator 112 |
| Transfer of health information to provider | 98.36% |
95.95%
2.4 pts better
|
Numerator 60 · Denominator 61 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 69 · Denominator 69 |
| Resident COVID-19 vaccinations up to date | 23.86% |
25.2%
1.3 pts worse
|
Numerator 21 · Denominator 88 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.7 |
2.1
0.6 pts worse
|
1.9
0.8 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.7 · Observed 2.9 · Expected 2.0 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.4 |
1.1
0.3 pts worse
|
1.8
0.4 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.4 · Observed 1.5 · Expected 1.7 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 98.9% |
93.0%
5.9 pts better
|
93.4%
5.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 99.2% · Q2 98.4% · Q3 99.2% · Q4 98.6% · 4Q avg 98.9% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
97.2%
2.8 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 1.9% |
2.4%
0.5 pts better
|
3.3%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 2.4% · Q3 1.5% · Q4 2.1% · 4Q avg 1.9% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 1.0% |
11.4%
10.4 pts better
|
11.4%
10.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.9% · Q2 0.9% · Q3 0.0% · Q4 2.3% · 4Q avg 1.0% |
| Percentage of long-stay residents who lose too much weight | 6.8% |
4.6%
2.2 pts worse
|
5.4%
1.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 9.2% · Q2 9.9% · Q3 5.4% · Q4 3.5% · 4Q avg 6.8% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 37.6% |
19.0%
18.6 pts worse
|
19.6%
18 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 37.1% · Q2 40.0% · Q3 36.6% · Q4 36.9% · 4Q avg 37.6% |
| Percentage of long-stay residents who received an antipsychotic medication | 28.5% |
13.5%
15 pts worse
|
16.7%
11.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 32.3% · Q2 28.6% · Q3 30.0% · Q4 23.6% · 4Q avg 28.5% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 7.2% |
9.8%
2.6 pts better
|
16.3%
9.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.9% · Q2 13.1% · Q3 2.9% · Q4 6.2% · 4Q avg 7.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 11.6% |
9.7%
1.9 pts worse
|
14.9%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.6% · Q2 17.1% · Q3 10.1% · Q4 6.5% · 4Q avg 11.6% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.9% |
0.7%
1.2 pts worse
|
1.0%
0.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 2.1% · Q3 1.9% · Q4 1.0% · 4Q avg 1.9% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.5% |
0.8%
0.7 pts worse
|
1.7%
0.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.4% · Q2 1.6% · Q3 1.5% · Q4 0.7% · 4Q avg 1.5% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 8.6% |
15.9%
7.3 pts better
|
19.8%
11.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.4% · Q2 7.6% · Q3 8.8% · Q4 6.0% · 4Q avg 8.6% |
| Percentage of long-stay residents with pressure ulcers | 7.1% |
6.0%
1.1 pts worse
|
5.1%
2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.1% · Q2 7.0% · Q3 6.6% · Q4 8.3% · 4Q avg 7.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 96.5% |
78.7%
17.8 pts better
|
81.7%
14.8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 95.1% · Q2 96.0% · Q3 96.5% · Q4 99.1% · 4Q avg 96.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 3.4% |
8.2%
4.8 pts better
|
12.0%
8.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 3.4% · Observed 3.5% · Expected 11.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.3% |
1.2%
0.9 pts better
|
1.6%
1.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.3% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 94.5% |
80.1%
14.4 pts better
|
79.7%
14.8 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 94.5% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 20.4% |
25.4%
5 pts better
|
23.9%
3.5 pts better
|
Short Stay · 20240701-20250630 · Adjusted 20.4% · Observed 21.7% · Expected 25.3% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-01-20 · Fire 2023-01-20
13 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (3 deficiencies)
6 fire-safety deficiencies
Top issue: Smoke (4 deficiencies)
Cycle 3
Health 2020-02-05 · Fire 2020-02-05
1 health deficiencies
Top issue: Resident Assessment and Care Planning (1 deficiency)
1 fire-safety deficiencies
Top issue: Services (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-07-09
E37 · Emergency Preparedness Deficiencies
Fire Safety
Establish staff and initial training requirements.
Corrected 2024-08-15
F · Potential for more than minimal harm
2024-07-09
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2024-08-15
F · Potential for more than minimal harm
2024-07-09
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
K374 · Smoke Deficiencies
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
K911 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Meet requirements for the installation and maintenance of electrical systems.
Corrected 2024-08-15
F · Potential for more than minimal harm
2023-01-20
K351 · Smoke Deficiencies
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2023-02-23
F · Potential for more than minimal harm
2023-01-20
K361 · Smoke Deficiencies
Fire Safety
Ensure that waiting areas, nurse’s stations, gift shops, and cooking facilities, open to the corridor are properly protected.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
K271 · Egress Deficiencies
Fire Safety
Have exits that are accessible at all times.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
K293 · Egress Deficiencies
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2023-02-23
E · Potential for more than minimal harm
2020-02-05
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2020-02-19
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-09-18
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2025-10-07
D · Potential for more than minimal harm
2025-09-18
F692 · Quality of Life and Care Deficiencies
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2025-10-07
E · Potential for more than minimal harm
2024-07-09
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2024-08-15
E · Potential for more than minimal harm
2024-07-09
F712 · Nursing and Physician Services Deficiencies
Health
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
Corrected 2024-08-15
E · Potential for more than minimal harm
2024-07-09
F921 · Environmental Deficiencies
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F583 · Resident Rights Deficiencies
Health
Keep residents' personal and medical records private and confidential.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F623 · Resident Rights Deficiencies
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F661 · Resident Assessment and Care Planning Deficiencies
Health
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F688 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F728 · Nursing and Physician Services Deficiencies
Health
Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F732 · Nursing and Physician Services Deficiencies
Health
Post nurse staffing information every day.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F761 · Pharmacy Service Deficiencies
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F842 · Resident Assessment and Care Planning Deficiencies
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F882 · Infection Control Deficiencies
Health
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected 2024-08-15
D · Potential for more than minimal harm
2024-07-09
F883 · Infection Control Deficiencies
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2024-08-15
J · Immediate jeopardy
2023-01-20
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2023-02-23
G · Actual harm
2023-01-20
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-02-23
F · Potential for more than minimal harm
2023-01-20
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
F711 · Nursing and Physician Services Deficiencies
Health
Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
F725 · Nursing and Physician Services Deficiencies
Health
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Corrected 2023-02-23
E · Potential for more than minimal harm
2023-01-20
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-02-23
D · Potential for more than minimal harm
2023-01-20
F584 · Resident Rights Deficiencies
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2023-02-23
D · Potential for more than minimal harm
2023-01-20
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2023-02-23
D · Potential for more than minimal harm
2023-01-20
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2023-02-23
D · Potential for more than minimal harm
2023-01-20
F865 · Administration Deficiencies
Health
Have a plan that describes the process for conducting QAPI and QAA activities.
Corrected 2023-02-23
E · Potential for more than minimal harm
2020-02-05
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2020-02-19
Penalties and ownership
What sits behind the stars
Ownership
Cg Healthcare LLC
5% Or Greater Direct Ownership Interest · Organization
Eisenreich, Avery
5% Or Greater Direct Ownership Interest · Individual
Reyes, Grace
W-2 Managing Employee · Individual
Stern, Samuel
Corporate Director · Individual
Stern, Samuel
Corporate Officer · Individual
Stern, Samuel
W-2 Managing Employee · Individual
Nearby options
Other facilities in reach
#1
Canterbury At Cedar Grove
Cedar Grove, NJ
1-star overall rating with 1-star inspections with $9,661 in total fines with 12 recent health deficiencies with 12 fire-safety deficiencies in the latest cycle
#2
Complete Care At Cedar Grove
Cedar Grove, NJ
4-star overall rating with 3-star inspections with 6 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Complete Care At St Vincents LLC
Cedar Grove, NJ
5-star overall rating with 5-star inspections with 8 fire-safety deficiencies in the latest cycle
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