Linden Center For Nursing And Rehabilitation

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and interviews conducted during the Recertification and Complaint survey, the facility did not ensure safe food storage was practiced to prevent food-borne illness. This was evident during the initial tour of the Kitchen. Specifically, (1) expired enteral feed nutritional supplement was observed in the Kitchen's dry storage room and 8 oz cartons of enteral feeding/supplement in the water storage cage in the kitchen. (2) the facility did not ensure that potentially hazardous foods were kept at 41 degrees or below during tray line observation for the Kitchen observation. The findings are: The facility policy titled Food Storage implemented 10/13/2016 documented foods are to be reported using the First-In, First-Out (FIFO) method; all new items should be stored behind items already in inventory. The facility policy titled Dietary/Food Handling implemented 10/2019 and revised 10/2022 documented all potentially hazardous food must be maintained at 40 degrees or less and at 140 or…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and staff interview conducted during the recertification survey (GW6011), the facility did not maintain an effective pest control program so that the facility is free of pests and rodents. Specifically, droppings were observed in the kitchen and emergency food and emergency water storage areas. This was evident for the Kitchen Observation facility task. The finding is: The facility policy titled Pest Control reviewed 11/2022 documented the facility will maintain an effective pest control program for insect and rodent control, food storage and proper cleaning is paramount. Pest control is carried out once weekly or more often if required. Under the direction of the Food Service Director, all areas of the kitchen are checked once week and as required. On 06/01/2023 at 10:19AM -10:34AM, an observation was made during the initial tour of the kitchen to include the Emergency Water in the cage in a 1-inch brown cockroach was seen crawling on the top metal shelf in the room. One…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record review conducted during the Recertification survey (GW6011) from [DATE] to [DATE], the facility did not ensure policies and procedures for advance directives were implemented to ensure advance directives would be followed. This was evident for 1 (Resident #73) of 2 resident reviewed for Advanced Directives out of 37 sampled residents. Specifically, Resident #73 had a Medical Orders for Life-Sustaining Treatment (MOLST) form indicating their Advanced Directives included Do Not Resuscitate (DNR)/Do Not Intubate (DNI), but Resident #73 had no orders for DNR/DNI in the medical record. In addition, the MOLST was not reviewed quarterly, and there were conflicting notes regarding the resident's code status in the medical record. The finding is: The policy and procedure titled Advanced Directives, revised [DATE], documented the facility healthcare staff educates residents with cognitive capacity to make informed decisions about their right to Medical Orders for Life Sustaining Treatment…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, record review, and staff interview conducted during the Recertification survey (GW6011), the facility did not ensure that medication and biologicals were discarded by expiration date. Specifically, one box of expired medication (Omeprazole) containing 3 bottles of extended-release capsules was located in the 2 [NAME] medication room. This was evident for 1 on 6 medication rooms reviewed for Medication Storage (Unit 2 West). The findings are: The Policy titled Medication Storage reviewed on 10/2022 documented medications must be removed and disposed of immediately if they are expired. Anytime you remove a medication from storage document the disposal on the medication disposition record and in the resident's file. On 06/03/2023 at 10:55 AM, an observation of the medication room on the 2 [NAME] was conducted with the Licensed Practical Nurse (LPN #2). There was one box of Omeprazole 20 mg 24-hour extended-release capsules containing 3 bottles of 14 capsules per bottle with an expiration date of 03/2023 in the medication room cabinet. The Medication Area…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and staff interviews during the recertification survey, the facility did not ensure that services provided or arranged by the facility meet practices and professional standards of quality. Specifically, on multiple occasions the Licensed Professional Nursing staff did not inform the medical staff when a resident's blood sugar levels were elevated and out of range. This deficient practice happened on multiple occasions for 1 resident out of 32 sampled residents. (Resident #149). The finding is: The facility policy Obtaining a Fingerstick Glucose Level dated March 14, 2016 documented that the purpose of the procedure is to obtain a blood sample to determine the resident' blood glucose level and to report results to the nursing supervisor and the Attending Physician. Resident # 149 was admitted to the facility on [DATE] with diagnoses that included Alzheimer's Disease and Diabetes Mellitus. The Quarterly Minimum Data Set (MDS ) 3.0 assessment dated [DATE] documented the resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review, during the recertification survey, the facility did not ensure that residents with limited mobility received appropriate services and assistance to maintain or improve mobility. Specifically, (1) a resident at risk for contractures with an order for right upper extremity (RUE) and left upper extremity (LUE) resting hand splints were observed on multiple occasions without RUE and LUE hand splints in place. (Resident #33). (2). a resident with an order for a hand roll for right hand contracture did not receive the device as ordered. (Resident #115). This was evident for 2 of 3 residents reviewed for Positioning and Mobility out of a sample of 38 residents. The findings are: 1. Resident #33 was admitted to the facility on [DATE] with diagnoses of Quadriplegia and Contracture of Muscle, Unspecified site. The Quarterly Minimum Data Set 3.0 assessment dated [DATE] documented the resident has intact cognition and range of motion impairment in the upper and lower…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and interviews conducted during the re-certification survey, the facility did not ensure that it promoted and facilitated resident self-determination through support of resident choice. Specifically, residents bathing preferences were not honored. This was evident for 2 of 2 residents reviewed for Choices out of 38 sampled residents. (Resident #104 and #263). The findings are: 1. Resident #104 was admitted to the facility on [DATE] with diagnoses that included Difficulty Walking, Muscle Weakness, Chronic Pain, and End Stage Renal Disease. The Quarterly Minimum Data Set 3.0 assessment dated [DATE] documented cognition as intact, and total dependence on staff for Activities of Daily Living (ADL's). There was no rejection of care documented. On 01/03/19 at 10:13 AM, the resident was observed in wheelchair in room, neatly dressed and groomed. During an interview the resident stated that he prefers a shower over bed bath and staff continues to wipe him down in bed. The resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review and interview the facility did not ensure that a resident was provided a homelike environment. Specifically, the resident's bedroom area was observed with no personal belongings. This was evident for 1 reviewed out of a sample of 38 residents (Resident #13). The Finding is: Resident #13 was admitted to the facility on [DATE] with diagnoses including Alzheimer's Disease, Non-Alzheimer's Dementia, and Schizophrenia. On 01/07/19 at 11:19 AM, during the initial pool process screening, and on 01/08/19 thru 01/10/19 the resident's room [ROOM NUMBER] bed B area was observed to be lacking any evidence of personal belongings, and not homelike. The Annual MDS dated [DATE] assessed the resident as being verbal with moderate impairment in cognition and has very important recreational activity preferences of having books, listening to music, being around pets, doing things with groups/favorite activities, going outside, participating in religious activities. It further stated the resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record review, and staff interviews during the recertification survey, the facility did not develop and implement a Comprehensive Care Plan (CCP) to reflect services that were to be furnished to attain or maintain the resident's highest practicable physical well-being. Specifically, there was no care plan created for a resident with a diagnosis of Diabetes Mellitus who was currently on a finger-stick regimen. This was evident for 1 of 38 sampled residents. (Resident # 273). The findings are: The facility policy Care Planning-Interdisciplinary Team dated March 14, 2016 documented the Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident and the care plan is based on the resident's comprehensive assessment. Resident #273 was admitted to the facility on [DATE] with diagnoses that included Diabetes Mellitus Type 1, and Non-Alzheimer's Dementia. The Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE]…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record reviews and staff interviews during a recertification survey, the facility did not ensure that the attending physician reviewed the resident's total program of care, including medications and treatments, at each visit. Specifically, there was no documented evidence that the attending physician evaluated the resident's medication regimen and made a determination about the continued appropriateness of the resident's current medication regimen which included the use of a psychotropic medication. This was evident for 1 of 38 sampled residents. (Resident # 5). The findings are: Resident # 5 was admitted to the facility on [DATE] with diagnoses that included Recurrent Depressive Disorder, Low Back Pain, and Lower Left Leg Amputation. The Annual Minimum Data Set (MDS) dated [DATE] indicated that the had intact cognition, required extensive assistance with Activities of Daily Living (ADLs), did not reject care and received an antidepressant 7 out of 7 days. The Comprehensive Care Plan (CCP) uses…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, record reviews and staff interviews during a recertification survey, the facility did not ensure that the resident's drug regimen was free of unnecessary medications. Specifically, a resident was prescribed psychotropic medication without a psychiatric evaluation and with no evidence of behaviors to support ongoing use of psychotropic medication. This was evident for 1 of 5 residents reviewed for the use of unnecessary medication. (Resident #5). The findings are: Resident # 5 was admitted to the facility on [DATE] with diagnoses that included Recurrent Depressive Disorder, Low Back Pain, and Lower Left Leg Amputation. The Annual Minimum Data Set (MDS) dated [DATE] indicated that the had intact cognition, required extensive assistance with Activities of Daily Living (ADLs), did not reject care and received an antidepressant 7 out of 7 days. The Comprehensive Care Plan (CCP) uses antidepressant medication r/t Depression revised 11/3/18 documented the following goal and interventions: Goal-…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations record review and interviews, during the re-certification survey, the facility did not ensure that menus are followed. Specifically, a resident who expressed a preference for no eggs and whose meal ticket specified no eggs was served eggs during breakfast on two separate occasions. This was evident for 1 of 5 residents reviewed for Food out of a sample of 38 residents. (Resident #104) The findings include: Resident #104 was admitted to the facility on [DATE] with diagnoses that include Dysphagia, Hypertension, and Diabetes Mellitus. The Quarterly Minimum Data Set 3.0 assessment dated [DATE] documented cognition as intact, and limited assistance of 1 person with eating. In an interview on 01/03/19 10:13 AM, Resident #104 stated that he does not like eggs and frequently receives eggs in his breakfast meal. State Agent observed tray with uneaten breakfast meal which included eggs. The resident also stated that he is not offered alternatives and his wife often brings him food that he likes. On…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interviews during the recertification survey, the facility did not ensure that it provided a sanitary environment to help prevent the development and transmission of communicable diseases and infections. Specifically, observations made in the laundry area revealed that there were multiple areas in the laundry room that was not clean, or well maintained. The findings are: On 01/09/2019 at 01:10 PM, the following were observed in the laundry room: - Laundry bins in disrepair, -Walls were chipped, dirty, in need of painting, -Water drain area in the middle of the floor in the laundry was dirty and clogged, -The back of the washing machines was littered with paper and other debris, -Floor in need of sweeping, cleaning and buffing. The floor had a build up of dirt, dust, and stripping paint, cracked tiles, and used gloves were discarded on the floor, -Three milk crates filled with dirty, used mops placed next to the washing machine, -Washing machine and dryer soiled with cream, brown and white colored streaks, -A pair of dirty sneakers, a back pack, a sweat shirt…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.