Shore Gardens Rehabilitation and Nursing Center

In the surveyor’s words

From the most serious findings on record at Shore Gardens Rehabilitation and Nursing Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF678Jun 26, 2026

  Based on interviews, medical record review, and other pertinent facility documents, it was determined that the facility failed to immediately activate their emergency response system including rapid identification of a resident's code status, initiating a code blue (facility alert system), initiating Cardiopulmonary Resuscitation (CPR) and calling emergency services/911, for a resident (Resident #142) who was found unresponsive and was a full-code status (all resuscitation procedures will be provided when a person stops breathing or their heart stops beating), in accordance with Basic Life Support (BLS) for Healthcare Providers. […]

• Immediate jeopardy, isolatedF610Nov 22, 2024

  C#: NJ00179177, NJ00179069 Based on interviews, medical records reviews, and review of other pertinent facility documentation on 11/11/2024, 11/12/2024, and 11/22/2024, it was determined that the facility failed to investigate an allegation of Resident-to-Resident sexual abuse between two residents, a cognitively impaired resident (Resident #1), who wanders and requires frequent monitoring and Resident #4, who has moderate cognitive impairment. On 9/24/2024 at 8:35 p.m., the License Nursing Home Administrator (LNHA) received a grievance by email written by Resident #1's family member, which included an alleged allegation of sexual interaction between Resident #1 and Resident #4. The LNHA forwarded the email to the Social Worker (SW) with instructions to write a Grievance. […]

• Actual harm, isolatedF689Jun 26, 2026

  Complaint #3007960Based on interviews, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure a resident (Resident #144), who was dependent on staff for transfers, was safely and properly transferred with two staff members via a mechanical lift. On 5/4/26, the resident was transferred by one staff member from their bed to a shower chair, which resulted in the resident sustaining a left upper extremity humeral fracture (a fracture of the left upper arm). […]

• Actual harm, isolatedF684Jan 5, 2026

  Complaint #: 374226Based on interviews, review of medical records, and review of other pertinent facility documents on 12/30/2025, it was determined that the facility failed to ensure that residents received care and services necessary to attain or maintain the highest practicable physical well-being, in accordance with professional standards of practice, by failing to properly assess, acknowledge pain, monitor, notify provider, and implement appropriate interventions for an identified unwitnessed fall and femur fracture.This deficient practice was identified for 1 of 3 residents reviewed (Resident #1), as evidenced by the following:Reference: New Jersey Statutes, Annotated Title 45, Chapter 11. Nursing Board. […]

• No harm, potential for more than minimal, widespreadF576Jun 26, 2026

  Based on interviews and a review of facility provided documents, it was determined that the facility failed to a). provide Saturday mail services to residents, and b) provide mail unopened. This deficient practice was identified for six (6) of six (6) residents interviewed during the Resident Council group meeting (Residents #12, # 47, 48, #62, #77, and #104) and was evidenced by the following:On 6/23/2026 at 10:30 AM, the surveyor conducted the Resident Council (RC) meeting with the residents referenced above. During RC, the surveyor asked the residents if they received their mail uponened and on Saturdays. Resident #12, #47, #48, #62, #77, and #104, all stated that they received their mail opened. […]