Inspection Reports for Linden Center for Nursing and Rehabilitation
NY, 11207
Back to Facility ProfileDeficiencies (last 5 years)
Deficiencies (over 5 years)
7.4 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
45% worse than New York average
New York average: 5.1 deficiencies/yearDeficiencies per year
16
12
8
4
0
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 6
Date: Jun 11, 2025
Visit Reason
Complaint Survey with 8 health citations and 0 life safety citations; deficiencies mostly Level 2 with isolated scope; all corrected by August 9, 2025.
Findings
Complaint Survey with 8 health citations and 0 life safety citations; deficiencies mostly Level 2 with isolated scope; all corrected by August 9, 2025.
Deficiencies (6)
Accuracy of assessments
Care plan timing and revision
Free of accident hazards/supervision/devices
Infection control
Medicaid/medicare coverage/liability notice
Reporting of alleged violations
Inspection Report
Complaint Investigation
Capacity: 60
Deficiencies: 13
Date: Jun 8, 2023
Visit Reason
Complaint Survey with 7 health citations and 7 life safety citations; deficiencies mostly Level 2 with isolated or pattern scope; all corrected by August 7-9, 2023.
Findings
Complaint Survey with 7 health citations and 7 life safety citations; deficiencies mostly Level 2 with isolated or pattern scope; all corrected by August 7-9, 2023.
Deficiencies (13)
Develop/implement comprehensive care plan
Food procurement,store/prepare/serve-sanitary
Label/store drugs and biologicals
Maintains effective pest control program
Notify of changes (injury/decline/room, etc.)
Reporting of alleged violations
Request/refuse/dscntnue trmnt;formlte adv dir
Gas equipment - cylinder and container storag
Hazardous areas - enclosure
Hvac
Means of egress - general
Subdivision of building spaces - smoke barrie
Vertical openings - enclosure
Inspection Report
Recertification
Deficiencies: 3
Date: Jun 8, 2023
Visit Reason
The inspection was conducted as a Recertification and Abbreviated survey from 06/01/2023 to 06/08/2023 to assess compliance with regulatory requirements including notification of changes, abuse reporting, and care planning.
Complaint Details
The complaint investigation revealed that an incident of resident-to-resident abuse involving Resident #573 was not reported to the New York State Department of Health within the required 2-hour timeframe. The facility investigated and determined no abuse occurred but failed to comply with timely reporting requirements.
Findings
The facility failed to immediately notify a resident's designated representative of a significant change in condition, failed to timely report alleged abuse to the state, and did not develop comprehensive care plans including prescribed treatments for residents. These deficiencies affected a few residents and were associated with minimal harm or potential for harm.
Deficiencies (3)
Failure to immediately notify resident's designated representative of significant change in condition and treatment initiation for Resident #473.
Failure to timely report alleged resident-to-resident abuse to the New York State Department of Health within 2 hours for Resident #573.
Failure to develop and implement a comprehensive person-centered care plan including prescribed eye drops for Resident #63.
Report Facts
Residents reviewed for Notification of Change: 38
Residents reviewed for Abuse: 3
Residents sampled for care plan review: 37
Brief Interview for Mental Status (BIMS) score: 3
Blister measurements: 4
Blister measurements: 9
Blister measurements: 7
Blister measurements: 8
Blister measurements: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| LPN #6 | Licensed Practical Nurse | Interviewed regarding notification of family about Resident #473's blisters and treatment |
| RNS #2 | Registered Nurse Supervisor | Interviewed regarding notification attempts to family and wound team communication for Resident #473 |
| WN | Wound Nurse | Interviewed about wound care and family notification attempts for Resident #473 |
| DNS | Director of Nursing Services | Interviewed about facility policy and failure to notify family for Resident #473 |
| LPN #3 | Licensed Practical Nurse | Interviewed about care plan and eye drop treatment for Resident #63 |
| Optometrist | Interviewed regarding Resident #63's blindness and glaucoma treatment | |
| Director of Nursing | Interviewed about care plan updates for Resident #63 | |
| DON | Director of Nursing | Interviewed about abuse investigation and reporting for Resident #573 |
| Administrator | Interviewed about reporting requirements for resident-to-resident altercations |
Inspection Report
Annual Inspection
Deficiencies: 5
Date: Jun 8, 2023
Visit Reason
The inspection was a Recertification survey conducted to assess compliance with regulatory requirements for nursing homes, including review of advance directives, medication storage, food safety, pest control, and other facility operations.
Findings
The facility was found deficient in ensuring proper implementation of advance directives, medication storage including removal of expired medications, safe food storage and temperature control, and maintaining an effective pest control program. Specific issues included missing DNR/DNI orders in medical records, expired medications present in medication rooms, expired enteral feeding supplements, potentially hazardous foods not kept at proper temperatures, and evidence of pests such as roaches, flies, and rodents in kitchen and storage areas.
Deficiencies (5)
Failure to ensure policies and procedures for advance directives were implemented, resulting in missing DNR/DNI orders and conflicting documentation for Resident #73.
Expired medication (Omeprazole) found in medication storage room, indicating failure to discard expired drugs promptly.
Expired enteral feeding nutritional supplements found in kitchen dry storage and emergency water storage areas.
Potentially hazardous foods were not maintained at 41 degrees Fahrenheit or below during tray line observations.
Facility did not maintain an effective pest control program; multiple pest sightings and droppings observed in kitchen and storage areas.
Report Facts
Medication rooms reviewed: 6
Expired Omeprazole bottles: 3
Residents reviewed for advance directives: 37
Residents with advance directives reviewed: 2
Residents affected by advance directive deficiency: 1
Pest control service visits: 19
Rodent droppings observed: 29
Food temperatures observed: 47.3
Food temperatures observed: 47.8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Licensed Practical Nurse #4 | Licensed Practical Nurse | Interviewed regarding Resident #73's DNR/DNI orders and medication orders |
| Social Worker | Social Worker | Interviewed regarding advance directives discussions and documentation for Resident #73 |
| ADON/RN | Assistant Director of Nursing / Registered Nurse | Interviewed about Resident #73's advance directives and order entry |
| Director of Nursing | Director of Nursing | Interviewed about advance directives process and medication storage rounds |
| LPN #1 | Licensed Practical Nurse | Interviewed about medication expiration checks |
| LPN #2 | Licensed Practical Nurse | Interviewed about medication storage and expiration checks |
| Registered Nurse Supervisor #1 | Registered Nurse Supervisor | Interviewed about medication checks and expired medications |
| Director for Food Services | Director for Food Services | Interviewed about food storage, pest control, and food temperature monitoring |
| Dietary Aide #1 | Dietary Aide | Interviewed about food stocking and noticing expired enteral feeding |
| Food Service Supervisor | Food Service Supervisor | Interviewed about food delivery rounds, pest sightings, and pest control |
| Dietary Aide #2 | Dietary Aide | Interviewed about food preparation and temperature control |
| Infection Preventionist | Infection Preventionist | Interviewed about environmental rounds and pest control monitoring |
Inspection Report
Capacity: 60
Deficiencies: 1
Date: Feb 15, 2022
Visit Reason
Covid-19 Survey with 1 health citation; deficiency Level 0 and corrected by April 14, 2022.
Findings
Covid-19 Survey with 1 health citation; deficiency Level 0 and corrected by April 14, 2022.
Deficiencies (1)
Responsibilities of providers; required notif
Inspection Report
Annual Inspection
Deficiencies: 0
Date: Dec 16, 2020
Visit Reason
The document is an annual inspection report for Linden Center for Nursing and Rehabilitation conducted to assess compliance with health regulations.
Findings
No health deficiencies were found during the inspection.
Inspection Report
Re-Inspection
Deficiencies: 9
Date: Jan 10, 2019
Visit Reason
The inspection was a re-certification survey to assess compliance with federal regulations regarding resident rights, care planning, quality of care, medication management, infection control, and other regulatory requirements.
Findings
The facility was found deficient in multiple areas including failure to honor resident bathing preferences, lack of a homelike environment for a resident, incomplete care plans, failure to notify medical staff of elevated blood sugars, inadequate mobility assistance, lack of physician review of psychotropic medication, failure to implement gradual dose reductions for psychotropic medications, failure to follow resident dietary preferences, and unsanitary conditions in the laundry area.
Deficiencies (9)
Failure to promote and facilitate resident self-determination through support of resident choice, specifically residents' bathing preferences were not honored.
Failure to ensure a homelike environment; resident's bedroom lacked personal belongings.
Failure to develop and implement a comprehensive care plan for a resident with Diabetes Mellitus.
Failure to ensure nursing staff informed medical staff of elevated blood sugar levels as ordered.
Failure to provide appropriate care to maintain or improve range of motion and mobility; residents observed without ordered splints or hand rolls.
Failure to ensure attending physician reviewed resident's care, including medication regimen and psychotropic medication use, at each required visit.
Failure to implement gradual dose reductions and non-pharmacological interventions for psychotropic medication; resident prescribed psychotropic medication without psychiatric evaluation or evidence of behaviors supporting ongoing use.
Failure to follow resident dietary preferences; resident who expressed no eggs preference was served eggs on two occasions.
Failure to provide and maintain a sanitary environment in the laundry room, including dirty and disorganized conditions.
Report Facts
Residents reviewed: 38
Residents affected: 2
Blood sugar elevated occasions: 16
Blood sugar elevated occasions: 13
Blood sugar elevated occasions: 3
Blood sugar elevated occasions: 17
Blood sugar elevated occasions: 4
Blood sugar elevated occasions: 5
Residents with devices: 10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nursing Assistant #5 | CNA | Interviewed regarding resident bathing preferences and refusal |
| Certified Nursing Assistant #4 | CNA | Interviewed regarding resident shower refusals and documentation |
| Licensed Practical Nurse #2 | LPN | Interviewed regarding documentation of resident shower refusals |
| Registered Nurse #3 | RN | Interviewed regarding shower documentation and resident care |
| Social Worker | SW | Interviewed regarding resident personal belongings and family communication |
| Registered Nurse Unit Manager | RN Unit Manager | Interviewed regarding care plan development and blood sugar notification |
| Attending Physician | MD | Interviewed regarding notification of elevated blood sugars and psychotropic medication monitoring |
| Licensed Practical Nurse #1 | LPN | Interviewed regarding communication of device use to CNAs |
| Registered Nurse #2 | RN | Interviewed regarding device monitoring and resident refusals |
| Registered Dietitian | RD | Interviewed regarding resident food preferences and meal rounds |
| Food Service Director | FSD | Interviewed regarding meal preparation and ticketing process |
| Food Service Worker | FSW | Interviewed regarding tray checking and error reporting |
| Director of Housekeeping | DON | Interviewed regarding laundry room cleaning and maintenance |
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