Cycle 1
Health 2025-06-17 · Fire 2025-06-17
7 health deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
13 fire-safety deficiencies
Top issue: Egress (4 deficiencies)
Vineland, NJ
Bishop Mccarthy Center For Rehab & Healthcare
2-star overall rating with 2-star inspections with 7 recent health deficiencies with 13 fire-safety deficiencies in the latest cycle
1045 E Chestnut Ave, Vineland, NJ
(856) 692-2850
Overall
2 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
182
Certified beds
Average residents
177
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Center Management Group
Operator or chain grouping
Approved since
1975-01-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
17 facilities
Chain averages 3 overall / 3 health / 2 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
0.27
Registered nurse staffing · state 0.69 · national 0.68
LPN hours / resident day
0.97
Licensed practical nurse staffing · state 0.94 · national 0.87
Aide hours / resident day
2.17
Nurse aide staffing · state 2.23 · national 2.35
Total nurse hours
3.41
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.24
RN + LPN hours · state 1.62 · national 1.54
Weekend hours
3.14
Weekend nurse staffing · state 3.45 · national 3.43
Weekend RN hours
0.11
Weekend registered nurse coverage · state 0.49 · national 0.47
Physical therapist
0.11
Reported PT staffing · state 0.11 · national 0.07
Adjusted RN hours
0.27
CMS adjusted RN staffing hours
Adjusted total hours
3.43
CMS adjusted total nurse staffing hours
Case-mix index
1.36
Higher values indicate more complex resident acuity
RN turnover
63%
Annual RN turnover · state 39% · national 45%
Total nurse turnover
60%
Annual nurse turnover · state 41% · national 46%
SNF VBP
Value-based purchasing
Program rank
13,180
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
7.67
Composite VBP score used to determine payment impact.
Payment multiplier
0.9807
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0
Baseline 22.82% · Performance 23.53% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
0
Baseline 8.89% · Performance 9.90% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
2.13
Baseline 48.72% · Performance 54.97% · Measure score 2.13 · Achievement 2.13 · Improvement 0
Adjusted total nurse staffing
0.94
Baseline 3.44 hours · Performance 3.34 hours · Measure score 0.94 · Achievement 0.94 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.01% |
10.72%
1.7 pts better
|
No Different than the National Rate · Eligible stays 174 · Observed rate 8.05% · Lower 95% interval 6.45% |
| Discharge to community | 51.02% |
50.57%
0.5 pts better
|
No Different than the National Rate · Eligible stays 153 · Observed rate 41.18% · Lower 95% interval 43.35% |
| Medicare spending per beneficiary | 1.38 |
1.02
0.4 pts worse
|
|
| Drug regimen review with follow-up | 99.14% |
95.27%
3.9 pts better
|
Numerator 230 · Denominator 232 |
| Falls with major injury | 0.43% |
0.77%
0.3 pts better
|
Numerator 1 · Denominator 232 |
| Discharge self-care score | 57.26% |
53.69%
3.6 pts better
|
Numerator 67 · Denominator 117 |
| Discharge mobility score | 46.15% |
50.94%
4.8 pts worse
|
Numerator 54 · Denominator 117 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 232 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 9.9% |
7.12%
2.8 pts worse
|
Worse than the National Rate · Eligible stays 148 · Observed rate 15.54% · Lower 95% interval 7.16% |
| Staff COVID-19 vaccination coverage | 1.8% |
8.2%
6.4 pts worse
|
Numerator 3 · Denominator 167 |
| Staff flu vaccination coverage | 83.93% |
42%
41.9 pts better
|
Numerator 141 · Denominator 168 |
| Discharge function score | 53.85% |
56.45%
2.6 pts worse
|
Numerator 63 · Denominator 117 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 105 · Denominator 105 |
| Transfer of health information to patient | 96.92% |
96.28%
0.6 pts better
|
Numerator 63 · Denominator 65 |
| Resident COVID-19 vaccinations up to date | 13.28% |
25.2%
11.9 pts worse
|
Numerator 17 · Denominator 128 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.8 |
2.1
0.3 pts better
|
1.9
0.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 2.1 · Expected 2.2 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.5 |
1.1
0.4 pts worse
|
1.8
0.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.5 · Observed 1.5 · Expected 1.7 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 91.4% |
93.0%
1.6 pts worse
|
93.4%
2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 84.3% · Q2 91.0% · Q3 93.6% · Q4 95.9% · 4Q avg 91.4% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 89.9% |
97.2%
7.3 pts worse
|
95.5%
5.6 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 89.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.9% |
2.4%
1.5 pts better
|
3.3%
2.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.7% · Q2 1.5% · Q3 0.7% · Q4 0.7% · 4Q avg 0.9% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 71.1% |
11.4%
59.7 pts worse
|
11.4%
59.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 69.9% · Q2 67.6% · Q3 72.8% · Q4 73.3% · 4Q avg 71.1% |
| Percentage of long-stay residents who lose too much weight | 7.5% |
4.6%
2.9 pts worse
|
5.4%
2.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.0% · Q2 6.7% · Q3 10.9% · Q4 7.1% · 4Q avg 7.5% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 12.5% |
19.0%
6.5 pts better
|
19.6%
7.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 15.2% · Q2 13.6% · Q3 10.9% · Q4 10.6% · 4Q avg 12.5% |
| Percentage of long-stay residents who received an antipsychotic medication | 3.7% |
13.5%
9.8 pts better
|
16.7%
13 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 2.2% · Q3 3.2% · Q4 4.8% · 4Q avg 3.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.2% |
0.1%
0.1 pts worse
|
0.1%
0.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.7% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.2% |
| Percentage of long-stay residents whose ability to walk independently worsened | 6.6% |
9.8%
3.2 pts better
|
16.3%
9.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.7% · Q2 10.3% · Q3 4.3% · Q4 3.4% · 4Q avg 6.6% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 5.5% |
9.7%
4.2 pts better
|
14.9%
9.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.9% · Q2 6.9% · Q3 5.6% · Q4 3.8% · 4Q avg 5.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.2% |
0.7%
0.5 pts better
|
1.0%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.8% · Q3 0.0% · Q4 0.0% · 4Q avg 0.2% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.2% |
0.8%
0.6 pts better
|
1.7%
1.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.7% · 4Q avg 0.2% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 27.9% |
15.9%
12 pts worse
|
19.8%
8.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 35.2% · Q2 27.9% · Q3 28.6% · Q4 20.6% · 4Q avg 27.9% |
| Percentage of long-stay residents with pressure ulcers | 2.1% |
6.0%
3.9 pts better
|
5.1%
3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.1% · Q2 0.9% · Q3 1.8% · Q4 3.4% · 4Q avg 2.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 73.5% |
78.7%
5.2 pts worse
|
81.7%
8.2 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 43.5% · Q2 69.8% · Q3 92.4% · Q4 86.7% · 4Q avg 73.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 13.3% |
8.2%
5.1 pts worse
|
12.0%
1.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 13.3% · Observed 13.7% · Expected 11.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.2%
1.2 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 71.1% |
80.1%
9 pts worse
|
79.7%
8.6 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 71.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 30.3% |
25.4%
4.9 pts worse
|
23.9%
6.4 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 30.3% · Observed 34.8% · Expected 27.4% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-03-28 · Fire 2024-03-28
8 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Cycle 3
Health 2022-01-04 · Fire 2022-01-04
10 health deficiencies
Top issue: Resident Rights (3 deficiencies)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-06-17
E37 · Emergency Preparedness Deficiencies
Fire Safety
Establish staff and initial training requirements.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
E39 · Emergency Preparedness Deficiencies
Fire Safety
Conduct testing and exercise requirements.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K225 · Egress Deficiencies
Fire Safety
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K271 · Egress Deficiencies
Fire Safety
Have exits that are accessible at all times.
Corrected 2025-08-15
F · Potential for more than minimal harm
2025-06-17
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 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K351 · Smoke Deficiencies
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K761 · Miscellaneous Deficiencies
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K916 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have a battery powered remote alarm panel in a location accessible by operating personnel.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K917 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure electrical receptacles or cover plates have distinctive color or marking.
Corrected 2025-07-30
F · Potential for more than minimal harm
2025-06-17
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2025-07-30
F · Potential for more than minimal harm
2024-03-28
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Corrected 2024-05-12
F · Potential for more than minimal harm
2024-03-28
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2024-06-03
E · Potential for more than minimal harm
2024-03-28
K371 · Smoke Deficiencies
Fire Safety
Have properly sized and located compartments to protect residents from smoke.
Corrected 2024-05-12
D · Potential for more than minimal harm
2022-01-04
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2022-03-10
Inspection history
Recent health citations
J · Immediate jeopardy
2025-08-06
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 2025-09-17
E · Potential for more than minimal harm
2025-06-17
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-07-30
D · Potential for more than minimal harm
2025-06-17
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 2025-07-30
D · Potential for more than minimal harm
2025-06-17
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2025-07-30
D · Potential for more than minimal harm
2025-06-17
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2025-07-30
D · Potential for more than minimal harm
2025-06-17
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 2025-07-30
D · Potential for more than minimal harm
2025-06-17
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-07-30
E · Potential for more than minimal harm
2024-09-26
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2024-11-15
E · Potential for more than minimal harm
2024-03-28
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-05-12
E · Potential for more than minimal harm
2024-03-28
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2024-05-12
E · Potential for more than minimal harm
2024-03-28
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-05-12
E · Potential for more than minimal harm
2024-03-28
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-05-12
E · Potential for more than minimal harm
2024-03-28
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 2024-05-12
D · Potential for more than minimal harm
2024-03-28
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 2024-05-12
D · Potential for more than minimal harm
2024-03-28
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 2024-05-12
F · Potential for more than minimal harm
2022-01-04
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2022-02-01
E · Potential for more than minimal harm
2022-01-04
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2022-02-01
D · Potential for more than minimal harm
2022-01-04
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2022-02-01
D · Potential for more than minimal harm
2022-01-04
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 2022-02-01
D · Potential for more than minimal harm
2022-01-04
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2022-02-01
D · Potential for more than minimal harm
2022-01-04
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 2022-02-01
D · Potential for more than minimal harm
2022-01-04
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2022-02-01
D · Potential for more than minimal harm
2022-01-04
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2022-03-17
C · Minimal harm
2022-01-04
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 2022-02-01
B · Minimal harm
2022-01-04
F582 · Resident Rights Deficiencies
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2022-02-01
Penalties and ownership
What sits behind the stars
Ownership
Vineland Ventures LLC
5% Or Greater Direct Ownership Interest · Organization
Gros, Charles-Edouard
5% Or Greater Indirect Ownership Interest · Individual
Boehm, Caroline
5% Or Greater Indirect Ownership Interest · Individual
Babroff, Sherri
Operational/Managerial Control · Individual
Klein, Baruch
Operational/Managerial Control · Individual
Levi, Shlomo
Operational/Managerial Control · Individual
Newport Real Estate Capital LLC
5% Or Greater Mortgage Interest · Organization
Sheetz, Maurice
Operational/Managerial Control · Individual
Stevanus, Amanda
Operational/Managerial Control · Individual
Thomas, Tinu
Operational/Managerial Control · Individual
Vinitsky, Avrohom
Operational/Managerial Control · Individual
Nearby options
Other facilities in reach
#1
New Jersey Veterans Memorial Vineland
Vineland, NJ
5-star overall rating with 4-star inspections with 3 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#2
Autumn Lake Healthcare At Vineland
Vineland, NJ
2-star overall rating with 2-star inspections with $7,901 in total fines with 11 recent health deficiencies with 9 fire-safety deficiencies in the latest cycle
#3
Millville Center
Millville, NJ
4-star overall rating with 3-star inspections with 4 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
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