Inspection Reports for
Bronx Gardens Rehabilitation and Nursing Center

The visit was complaint-related based on an incident where Resident #1 fell while receiving care. The facility's investigation concluded no evidence of abuse, neglect, exploitation, or mistreatment. The fall was due to Certified Nursing Assistant #1 failing to follow the plan of care requiring two-person assistance for bed mobility.

The facility failed to ensure adequate assistance consistent with the resident's needs to prevent accidents, resulting in a resident falling from bed and sustaining actual harm including head trauma. The investigation found that a Certified Nursing Assistant did not follow the resident's plan of care requiring two-person assistance for bed mobility.

Complaint Survey with 5 Standard Health Citations and 1 Life Safety Code Citation, all corrected by August 22, 2025 except emergency lighting which was not corrected by report date.

The facility failed to ensure food was stored according to professional standards, as staff food was found stored in a resident food refrigerator. The Food Service Director confirmed the violation and stated that dietary staff were reeducated on proper food storage practices.

Complaint Survey with 1 Standard Health Citation for reporting of alleged violations, corrected by April 30, 2025.

The visit was complaint-related, investigating an allegation that Resident #3 grabbed Resident #2's hands and held them by the throat on 01/02/2025. The allegation was unsubstantiated after investigation, but the facility did not report the allegation to the state as required.

The facility failed to ensure that an alleged abuse incident involving two residents was reported to the New York State Department of Health within the required timeframe. The investigation concluded that the alleged incident did not occur based on camera review, staff and resident interviews, and physical assessment, but the facility did not report the allegation as required by policy.

Complaint Survey with 6 Standard Health Citations and 10 Life Safety Code Citations, all corrected by July 11, 2023.

The facility was found deficient in timely reporting of alleged abuse to the state, development of person-centered care plans for new fractures, medication error rates exceeding 5%, improper medication storage, and improper garbage disposal practices.

The facility failed to timely report alleged abuse involving two residents' unwitnessed falls resulting in fractures to the New York State Department of Health within the required 2-hour timeframe. Additionally, the facility did not develop a person-centered care plan with measurable goals and interventions for one resident's left tibia fracture.

Complaint Survey with 4 Standard Health Citations related to abuse/neglect policies, investigation, reporting, and resident records, all corrected by January 25, 2022.

The facility failed to ensure that the Minimum Data Set (MDS) assessment accurately reflected a resident's dental status, as broken and carious teeth were not documented. This deficiency was identified through observation, record review, and interviews with staff and the resident.