New Jersey nursing homes let staff work without required background checks, audit finds

Why it matters

Background checks are a key safeguard for nursing home residents, many of whom are elderly, disabled or medically fragile. Gaps in screening can leave residents vulnerable to abuse, neglect or exploitation.

The big picture

Federal rules bar nursing homes from employing people with serious disqualifying histories. New Jersey is responsible for enforcing those rules, but a federal audit found significant weaknesses in how the state oversees compliance.

What they found

• Eleven of 12 nursing homes reviewed did not fully comply with background check requirements.
• Thirty-three of 120 employees reviewed either lacked required checks or had no proof checks were completed.
• Seventeen employees worked before their background checks were finished.
• Six employees worked without any background check at all.
• One facility provided no background check records for the employees reviewed.

Why it happened

State inspections reviewed only a small sample of employees, and some nursing homes did not have procedures in place to ensure background checks were completed before staff began working.

What’s next

Federal auditors recommended stronger oversight and clearer guidance for nursing homes. State health officials say inspections now review all new hires since the last survey and that additional training and outreach are planned.

New Jersey failed to consistently ensure that nursing homes complied with federal background check requirements for employees, according to a new audit that found widespread lapses that put residents at risk of abuse, neglect, and exploitation.

The audit, conducted by the U.S. Department of Health and Human Services Office of Inspector General, examined whether New Jersey properly enforced federal rules barring nursing homes from hiring people with serious disqualifying backgrounds during calendar year 2022. Audit work took place from May 2023 through October 2025.

Federal law requires nursing homes that participate in Medicare and Medicaid to screen employees to help protect residents. About 1.2 million people live in nursing homes nationwide, and more than half rely on Medicare or Medicaid to pay for their care.

Auditors reviewed the records of 10 employees at each of 12 nursing homes across New Jersey. They found that the state did not ensure compliance at 11 of the 12 facilities reviewed.

Altogether, those 11 nursing homes either failed to complete required background checks or could not show proof they had done so for 33 of the 120 employees examined.

According to the audit, nine nursing homes allowed 17 employees to work and provide care before their background checks were finished. Four nursing homes employed six people without conducting background checks at all. In another case, one nursing home could not provide any documentation showing background checks had been completed for the 10 employees selected for review.

The inspector general said these failures happened for two main reasons. First, the state’s inspection process did not review enough employees to reliably catch problems. Second, many nursing homes did not have strong procedures in place to make sure background checks were completed before staff began working.

Because of those gaps, residents were exposed to a higher risk of abuse, neglect, exploitation, or mistreatment, the report said.

The Office of Inspector General made two recommendations to the state: improve how New Jersey monitors nursing homes’ compliance with background check rules, and provide clearer guidance to facilities on how to properly conduct background checks under federal law.

State officials did not say whether they agreed or disagreed with the recommendations but outlined steps already taken and others planned in response to the audit.

The audit is part of a broader series of reviews looking at how well states oversee institutions that care for vulnerable people.

Federal rules prohibit nursing homes from employing people who have been found guilty of abusing or mistreating residents, exploiting them financially, or stealing resident property. The ban also applies to people with confirmed abuse findings on state nurse aide registries or active professional discipline related to abuse or neglect.

While the regulations do not explicitly require criminal background checks, the audit said the ban effectively requires them. Federal guidance states that nursing homes must thoroughly investigate the backgrounds of prospective employees.

The audit provided more detail about the workers who were allowed to start without proper screening. The 17 employees whose background checks were completed late included housekeepers, food service workers, activity staff, maintenance workers, receptionists and office staff. Some worked only a few days before checks were completed, while others worked for more than 16 years.

The six employees who were never screened included two administrators, a security guard, an office worker, a director of activities and a housekeeper. Those employees worked at the facilities for between one year and more than two decades.

In the case where no documentation was provided, the employees included licensed staff, certified nursing assistants and other nonlicensed workers. The nursing home said most had been hired by a previous owner but could not provide records showing any background checks were done.

The audit also looked at how New Jersey oversees nursing homes. The Department of Health inspects facilities about every 12 to 15 months to make sure they meet federal safety standards. During those inspections, surveyors typically review a small sample of recently hired employees and check for background screening, licensing and references.

The inspector general found that approach left large gaps because it only covered a short time window and did not ensure background checks were completed before employees began working.

To address the problems, the Office of Inspector General recommended that New Jersey expand how far back inspections look when reviewing employee files and require nursing homes to complete background checks for all employees — including contract workers — before they start work.

State health officials said that beginning in June 2023, inspections now include reviewing all new hires since the last inspection. They also said the state plans to increase outreach and education for nursing homes through provider communications and training opportunities.

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