Linden Center for Nursing and Rehabilitation

Inspectors wroteBased 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.

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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: [...]

Inspectors wroteBased 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).

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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.

Inspectors wroteBased 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).

Inspectors wroteBased 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. [...]

Inspectors wroteBased 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).

Inspectors wroteBased 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).

Inspectors wroteBased 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).

Inspectors wroteBased 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)

Inspectors wroteBased 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.