New Jersey › Bergen County › Englewood
Complete Care At Inglemoor, LLC
333 Grand Ave, Englewood, NJ 07631
Ratings are based on the most recent data available; a facility's ratings may have changed since the last update. The health inspection rating is based on the three most recent standard surveys and complaint investigations. CMS processed this record on 1 Aug 2026. View the Care Compare record.
Complete Care At Inglemoor, LLC, in Englewood, New Jersey, is certified for 62 beds under for-profit, limited liability company ownership and belongs to the Complete Care chain.
CMS gives it 2 of 5 stars overall, below the New Jersey median of 4; the health inspection rating is 2, staffing 3 and quality measures 3.
Inspectors recorded 39 health deficiencies across the three most recent survey cycles (19, 12, 8 by cycle, most recent first), none at the actual-harm level. That is 62.9 per 100 beds, more than the state median of 15.2.
CMS lists no fines or payment denials against the facility in the period covered.
Reported nurse staffing is 3.6 hours per resident per day (0.6 RN), close to the New Jersey median of 3.6; nursing staff turnover is 38.5%.
Compared with county, state and nation
| Measure | This facility | Bergen Co. median | New Jersey median | US average |
|---|---|---|---|---|
| Overall star rating | 2 | 3 | 4 | 3.0 |
| Health citations, 3 cycles | 39 | 22 | 21 | 28.7 |
| Citations per 100 beds | 62.9 | 14.8 | 15.2 | 26.8 |
| Total nurse hours per resident day | 3.6 | 3.7 | 3.6 | 3.9 |
| RN hours per resident day | 0.6 | 0.8 | 0.5 | 0.7 |
| Nursing staff turnover | 38.5% | 30.4% | 38.9% | 45.8% |
| Fines listed | $0 | $0 | $0 | — |
County and state figures are medians across facilities (29 in the county, 348 in the state); the US column is the CMS national average where CMS publishes one.
Citations by survey cycle
Dark bar: this facility. Grey bar: New Jersey average per facility for the same cycle, as published by CMS. Standard health survey dates: 13 Mar 2025, 26 Jan 2023.
Severity mix: D ×24 E ×11 F ×4
Health deficiencies
Every health citation in the current CMS record (three survey cycles), most recent first. Tag text is the CMS requirement summary, not the inspection narrative.
Scope and severity letters (A–L)
| Survey date | Tag | What the tag requires | Severity | Type | Corrected |
|---|---|---|---|---|---|
| 7 Nov 2025 | F0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | Complaint investigation | 8 Dec 2025 |
| 7 Nov 2025 | F0692 | Provide enough food/fluids to maintain a resident's health. | D | Complaint investigation | 17 Dec 2025 |
| 7 Nov 2025 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | Complaint investigation | 17 Dec 2025 |
| 13 Mar 2025 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | E | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0711 | Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | E | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | E | Complaint investigation | 11 Apr 2025 |
| 13 Mar 2025 | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0578 | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0610 | Respond appropriately to all alleged violations. | D | Complaint investigation | 2 Apr 2025 |
| 13 Mar 2025 | F0623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0641 | Ensure each resident receives an accurate assessment. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0661 | Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0692 | Provide enough food/fluids to maintain a resident's health. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0695 | Provide safe and appropriate respiratory care for a resident when needed. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0761 | 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. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | Standard survey | 11 Apr 2025 |
| 13 Mar 2025 | F0887 | Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | D | Standard survey | 11 Apr 2025 |
| 3 Dec 2024 | F0603 | Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). | D | Complaint investigation | 4 Dec 2024 |
| 26 Jan 2023 | F0880 | Provide and implement an infection prevention and control program. | F | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | E | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0758 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | E | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0886 | Perform COVID19 testing on residents and staff. | E | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | D | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0732 | Post nurse staffing information every day. | D | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0759 | Ensure medication error rates are not 5 percent or greater. | D | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D | Standard survey | 15 Mar 2023 |
| 26 Jan 2023 | F0814 | Dispose of garbage and refuse properly. | D | Standard survey | 15 Mar 2023 |
| 5 May 2021 | F0801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | F | Standard survey | 11 Jun 2021 |
| 5 May 2021 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard survey | 11 Jun 2021 |
| 5 May 2021 | F0756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | E | Standard survey | 11 Jun 2021 |
| 5 May 2021 | F0803 | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | E | Standard survey | 11 Jun 2021 |
| 5 May 2021 | F0880 | Provide and implement an infection prevention and control program. | E | Standard survey | 27 Jul 2021 |
| 5 May 2021 | F0881 | Implement a program that monitors antibiotic use. | E | Standard survey | 11 Jun 2021 |
| 5 May 2021 | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | Standard survey | 11 Jun 2021 |
| 5 May 2021 | F0761 | 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. | D | Standard survey | 11 Jun 2021 |
Penalties
CMS lists no fines or payment denials for this facility in the period covered.
Staffing
Hours per resident per day as reported through the Payroll-Based Journal; grey bars are the New Jersey average. Turnover: nursing staff 38.5%, RNs 44.4%; 0 administrators left in the reporting year.
Quality measures
| Measure | Residents | This facility | New Jersey median | US median |
|---|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 16.5% | 7.3% | 12.6% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 0.0% | 0.2% | 0.3% |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 0.5% | 0.4% | 0.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 4.5% | 2.0% | 2.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 0.6% | 0.9% | 1.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 15.4% | 6.6% | 12.5% |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 5.9% | 4.8% | 4.2% |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 17.8% | 11.8% | 13.4% |
Four-quarter averages for the measures CMS uses in the quality-measure star rating (2025Q2-2026Q1). Lower is better for every measure listed. Medians are computed across facilities on this site.
Ownership
Ownership type: for-profit, limited liability company. Legal business name: Complete Care At Inglemoor Llc. Chain: Complete Care (85 facilities).
| Organisation | Role in the CMS record | Interest | Since |
|---|---|---|---|
| Pc Nj1 Opcos LLC | 5% or greater direct ownership interest | 100% | 07/01/2021 |
| Pc Wta Opco Holdco LLC | 5% or greater indirect ownership interest | NO PERCENTAGE PROVIDED | 07/01/2021 |
| Welltower Inc | 5% or greater security interest | NOT APPLICABLE | 07/01/2021 |
| Inglemoor Center Realty, LLC | Adp of the snf | NOT APPLICABLE | 07/30/2021 |
| Pc Wta Acquisition LLC | Adp of the snf | NOT APPLICABLE | 07/01/2021 |
| Pc Wta Multi-State LLC | Adp of the snf | NOT APPLICABLE | 07/01/2021 |
| Peace Capital Holdings LLC | Adp of the snf | NOT APPLICABLE | 07/01/2021 |
| Welltower Inc | Adp of the snf | NOT APPLICABLE | 07/01/2021 |
Only organisations are shown. CMS also records individual owners, officers and managing employees; this site does not publish people's names.
Other nursing homes in Bergen County
| Facility | City | Beds | Overall | Health | Staffing | Citations | Per 100 beds | Fines | Last survey |
|---|---|---|---|---|---|---|---|---|---|
| Careone At Valley | Westwood | 98 | 5 | 5 | 2 | 8 | 8.2 | — | 24 Apr 2026 |
| Emerson Health Care Center | Emerson | 155 | 5 | 5 | 1 | 5 | 3.2 | — | 13 Feb 2023 |
| Family of Caring Healthcare At Ridgewood | Ridgewood | 96 | 5 | 4 | 4 | 16 | 16.7 | — | 5 May 2025 |
| New Jersey Veterans Memorial Home At Paramus | Paramus | 336 | 5 | 5 | 5 | 7 | 2.1 | — | 23 Jan 2026 |
| Woodcliff Lake Health & Rehabilitation Center | Woodcliff Lake | 114 | 5 | 5 | 2 | 7 | 6.1 | — | 6 May 2025 |
| Actors Fund Home | Englewood | 107 | 4 | 4 | 5 | 15 | 14.0 | — | 24 Jul 2025 |
| Allendale Rehabilitation and Healthcare Center | Allendale | 120 | 4 | 3 | 2 | 23 | 19.2 | — | 25 Nov 2025 |
| Atlas Rehabilitation and Healthcare At Maywood | Maywood | 120 | 4 | 3 | 2 | 18 | 15.0 | — | 11 Aug 2025 |
All 29 facilities in Bergen County
Questions and answers
How many deficiencies has Complete Care At Inglemoor, LLC been cited for?
39 health deficiencies across the three most recent survey cycles, 0 at the actual-harm or immediate-jeopardy level. The New Jersey median is 21 per facility.
Has Complete Care At Inglemoor, LLC been fined?
CMS lists no fines against the facility in the period covered.
How does staffing at Complete Care At Inglemoor, LLC compare?
Reported total nurse staffing is 3.6 hours per resident per day against a New Jersey median of 3.6 and a national average of 3.9.
Who operates Complete Care At Inglemoor, LLC?
It is part of the Complete Care chain. Ownership type is for-profit, limited liability company. Organisations in the CMS ownership record include Pc Nj1 Opcos LLC and Pc Wta Opco Holdco LLC. Individual owners and managers are not listed on this site.
When was Complete Care At Inglemoor, LLC last inspected?
The most recent survey or investigation in the CMS record is dated 7 Nov 2025; the most recent standard health survey was 13 Mar 2025.
Where does this data come from?
All figures are from the Centers for Medicare & Medicaid Services Care Compare datasets (provider information, health deficiencies, penalties, ownership and quality measures), processed 1 Aug 2026. Ratings and citations may change; the Care Compare record is authoritative.
Provenance
Source: Centers for Medicare & Medicaid Services, Care Compare nursing home datasets (provider information, health deficiencies, penalties, ownership, MDS quality measures, state and national averages), public domain, processed by CMS on 1 Aug 2026. Facility record: Care Compare. Errors in processing are corrected at the next daily build; see corrections.