The Estates at Linden LLC

In the surveyor’s words

From the most serious findings on record at The Estates at Linden LLC, in the surveyor’s own words.

• Actual harm, isolatedF697Nov 1, 2024

  Based on interview and document review, the facility failed to manage pain consistent with the comprehensive assessment, plan of care, and physician's orders and to ensure potential acute opioid withdrawal symptoms were assessed to prevent avoidable, significant, pain for 1 of 1 resident (R23) reviewed for pain management. This deficient practice caused actual harm for R23, who experienced unmanaged pain and withdrawal symptoms. Findings include: R23's face sheet printed 10/31/24, indicated R23 had diagnosis of chronic pain syndrome with chronic opioid use related to a motor vehicle accident (MVA). R23's quarterly minimum data set (MDS) dated [DATE], indicated R23 was cognitively intact with no rejection of care. […]

• No harm, potential for more than minimal, widespreadF812Nov 2, 2023

  Based on observation, interview and document review the facility failed to ensure food was labeled with an expiration date. The facility also failed to ensure food was prepared in a clean and sanitary environment. In addition, the facility failed to ensure the dishwasher temperatures were logged daily, and the chemical sanitization solution was at the correct concentration to ensure proper sanitization to prevent foodborne illness. This had the potential to affect all 34 residents in the facility. Findings include: Food Storage During an initial kitchen observation on [DATE] at 12:31 p.m., the following items were observed in the main kitchen: Refrigerator: -two half dozen bags of hard-boiled eggs, dated [DATE]. […]

• No harm, potential for more than minimal, widespreadF880Nov 2, 2023

  Based on observation, interview and document review, the facility failed to ensure a risk assessment and a water management program was developed and maintained to help reduce the risk of Legionnaire's Disease (Legionella) bacterial growth and subsequent contamination in the facility's water supply and/or storage. These findings had potential to affect all 34 residents, staff and visitors within the nursing home. Findings include: Review of the Centers for Disease Control and Prevention (CDC) website titled Legionella.Prevention and Control, dated 03/25/21, revealed, The key to preventing Legionnaires' disease is to reduce the risk of Legionella growth and spread. […]

• No harm, potential for more than minimal, isolatedF558Jan 8, 2026

  Based on observation, interview, and document review, the facility failed to ensure call lights were accessible for 1 of 1 resident (R11). Findings include:R11's modified significant change in status Minimum Data Set (MDS) dated [DATE], indicated R11 made himself understood and understood others, had moderate cognitive impairment, had impairment in range of motion to lower extremities, used a wheelchair, was dependent on staff for toileting hygiene, showering and bathing, and transfers. […]

• No harm, potential for more than minimal, isolatedF686Jan 8, 2026

  Based on observation, interview, and document review, the facility failed to implement pressure ulcer interventions for 1 of 1 resident (R11) reviewed for pressure ulcers.Findings include:R11's modified significant change in status Minimum Data Set (MDS) dated [DATE], indicated R11 had moderate cognitive impairment, had impairment in range of motion to lower extremities, used a wheelchair, was dependent on staff for most activities of daily living (ADLs) including putting on and taking off footwear and required substantial to maximal assistance with rolling left to right. […]