• CMS rates this facility 2/5 stars (below average)
• Has 120 certified beds with an average of 104.9 residents per day (87% occupancy)
• Last health inspection found 14 deficiencies (inspected Mar 7, 2025)
• Has been fined a total of $3,595 across 1 fine(s)
• Total nursing staff: 3.45 hours per resident per day
• Staff turnover rate: 51.7% (high)
• Part of the Complete Care chain (85 facilities)
Complete Care at Milford Manor LLC is a 2-star Medicare and Medicaid certified nursing home in West Milford, New Jersey with 120 certified beds. It has been operating since 1989. The facility scored below average compared to New Jersey facilities.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Keep residents' personal and medical records private and confidential.
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Provide enough food/fluids to maintain a resident's health.
Provide safe, appropriate pain management for a resident who requires such services.
Ensure each resident’s drug regimen must be free from unnecessary drugs.
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.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Provide and implement an infection prevention and control program.
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
Provide training in compliance and ethics.
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
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.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Plan the resident's discharge to meet the resident's goals and needs.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Provide safe, appropriate pain management for a resident who requires such services.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Ensure medication error rates are not 5 percent or greater.
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Provide and implement an infection prevention and control program.
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.
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Provide and implement an infection prevention and control program.
Staffing hours per resident per day. The black line shows the national average.
Quality measures as percentages of residents. Lower is better for all measures.
| Name | Role | Type | Ownership % | Since |
|---|---|---|---|---|
| MILFORD MANOR HOLDCO LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | Dec 27, 2021 |
| PC GC HOLDCO LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Organization | N/A | Dec 27, 2021 |
| PEACE CAPITAL HOLDINGS LLC (DE) | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Organization | N/A | Dec 27, 2021 |
| SMS 2021 TRUST | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | Organization | N/A | Dec 27, 2021 |
| AYDIN, EMMANUEL | OPERATIONAL/MANAGERIAL CONTROL | Individual | N/A | Dec 27, 2021 |
| REYES, GRACE | OPERATIONAL/MANAGERIAL CONTROL | Individual | N/A | Mar 13, 2023 |
| ZACKAI, RAANAN | OPERATIONAL/MANAGERIAL CONTROL | Individual | N/A | Dec 27, 2021 |
| STEIN, SHALOM | CORPORATE OFFICER | Individual | N/A | Dec 27, 2021 |
This chain operates 85 facilities. View all →