Above average — CMS composite of the measures below.
The next survey window likely opens around March 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Linden Ponds during CMS and state inspections, most recent first.
Resident Council concerns were not addressed or reported back to residents as required. Minutes showed repeated complaints about food, staff identification, music, laundry, and CNA communication, but no action plans or resident feedback were documented. During a council meeting, residents said concerns were often left unresolved and follow-up was uncommon. Staff said minutes were stored on a shared drive, not sent to dept heads, and no consistent follow-up occurred; the PM could not recall specific responses and could not provide action plans.
The facility failed to follow infection control precautions for two residents. One resident had MRSA and MDROs associated with a skin abscess and psoriasis, yet staff were observed entering the room and providing care without PPE despite Contact Precautions being posted. Another resident had a Foley catheter with an order for EBP, but a CNA was observed providing shower-related care and handling the catheter drainage bag without a gown.
A resident with severe cognitive impairment, right-sided hemiparesis, and multiple comorbidities had an individualized care plan and care card requiring total dependence on two staff for bathing, dressing, and bed mobility. A CNA who was familiar with the resident’s needs provided in-bed dressing care alone, despite knowing that two-person assistance was required. While turning the resident and pulling up pants, the resident slid off the bed, landed face down on the floor, and sustained a forehead laceration that required suturing in the ED.
A resident with severe cognitive impairment and multiple comorbidities, care planned as totally dependent and requiring a two-person assist for bathing, dressing, and bed mobility, was being provided morning care in bed by a single CNA. While the CNA turned the resident toward her near the edge of the bed and attempted to pull up the resident’s pants, the resident slid off the bed and landed face down on the floor, sustaining a forehead laceration that required suturing in the ED. Facility policies on fall management and lifting/bed mobility required assessment of assistance needs and communication of the required number of staff, and the resident’s care plan and care card clearly indicated the need for two staff; however, only one staff member was present and providing care at the time of the incident.
A resident with severe cognitive impairment reported being physically abused by a CNA, resulting in visible bruising. Although the allegation was promptly reported internally and investigated, administration failed to notify law enforcement of the suspected abuse until several weeks later, contrary to policy and regulatory requirements.
The facility failed to securely store medications, leaving them unattended in six residents' rooms. Medications were found on top of locked cabinets and in unlocked drawers, contrary to the facility's policy requiring secure storage. The DON confirmed that all prescription medications should be locked unless residents are assessed to self-administer.
Resident Council Concerns Not Addressed or Reported Back
Penalty
Summary
The facility failed to ensure grievances brought forward from the Resident Council were addressed and promptly resolved, and the residents were not provided feedback from the facility in response to their concerns. The facility policy for Resident or Family Group Meeting stated that concerns conveyed in the resident group meeting were to be responded to by department heads within 2 weeks with a written action plan, and that action plans and minutes were to be submitted to the Administrator for signature. However, review of the January, February, and March 2026 Resident Council Minutes showed repeated concerns including food quality and variety, staff identification, music in the living room, missing laundry items, and CNAs not talking to residents during care, with no action plans documented and no feedback included for the residents. During a Resident Council meeting attended by the surveyor, residents stated that complaints brought up during prior meetings were not addressed and remained unresolved, and that there was often no follow-up or feedback on concerns raised at monthly meetings. One resident reported bringing up a lack of medical care at a prior meeting and never receiving follow-up, while another resident stated that lack of follow-up was common and that a person needed to have a big mouth to get anyone to respond. Staff interviews confirmed that the designated staff members typed the minutes and stored them on a shared drive, but did not distribute them to department heads or follow up with department heads regarding concerns. The Program Manager stated follow-up had been verbal and could not recall specific follow-up for the food concerns, and she was unable to provide any action plans. The Administrator stated she was not aware the designated staff were not following up with the Resident Council and expected concerns raised at a meeting to be followed up at the next meeting.
Failure to Follow Contact Precautions and Enhanced Barrier Precautions
Penalty
Summary
The facility failed to follow infection control precautions for a resident with MRSA and multidrug-resistant organisms and for another resident with an indwelling urinary catheter. The report states that the facility did not adhere to Contact Precautions for a resident with a history of psoriasis, dementia, and a skin abscess, and did not implement Enhanced Barrier Precautions during Foley catheter care for a resident with urinary retention and a Foley catheter. For the resident on Contact Precautions, the care plan directed staff to maintain Contact Precautions due to positive MRSA and MDRO Proteus mirabilis on the left buttock, ongoing psoriatic plaque treatment, and cellulitis related to psoriasis. The wound culture from the resident’s buttock grew Veillonella dispar, multidrug-resistant Proteus mirabilis, MRSA, and Enterococcus faecalis. Surveyors observed multiple instances in which staff entered or remained in the resident’s room without PPE, including a CNA assisting with breakfast, sitting beside the bed, and helping complete a dining order, as well as an activities assistant entering without hand hygiene or PPE. Additional observations showed other staff in the room without PPE, and staff interviews reflected inconsistent understanding of when gowns and gloves were required. For the resident with the Foley catheter, the physician’s order required Enhanced Barrier Precautions due to the indwelling urinary catheter. During observation, a CNA was assisting the resident with a shower while wearing gloves and carrying the urinary catheter drainage bag, but no gown was observed. The CNA later stated the resident no longer required EBP, while the DON stated it was her expectation that staff implement EBP during high-contact care for the resident.
Failure to Follow Two-Person Assistance Care Plan Resulting in Resident Fall and Injury
Penalty
Summary
The deficiency involves the facility’s failure to ensure staff consistently implemented and followed an individualized comprehensive care plan requiring two staff members to assist a resident with bathing, dressing, and bed mobility. The facility’s own policies stated that each resident would have an individualized, person-centered care plan developed by the interdisciplinary team, and that care plans and associated care cards would guide direct care staff in providing care. The resident’s care plan and care card both specified total dependence on two staff members for bathing, dressing, and bed mobility. The resident involved had been admitted in October 2024 with multiple diagnoses, including dementia, cerebrovascular accident with right-sided hemiparesis, osteoarthritis, coronary artery disease, atrial fibrillation, hypertension, hyperlipidemia, and muscle weakness. A quarterly MDS assessment documented that the resident was severely cognitively impaired, with a BIMS score of 00, and was dependent on staff for bathing, dressing, and bed mobility. The resident’s care plan, dated 01/09/26, and the resident care card, which served as a quick reference for direct care staff, both indicated that the resident required the assistance of two staff members for these activities. On the morning of 01/14/26, a care associate assigned to the resident provided care and attempted to dress the resident in bed without obtaining assistance from a second staff member, despite knowing from the care card and her prior experience that two-person assistance was required for bed mobility and in-bed care. While the care associate was turning the resident and pulling on the resident’s pants, the resident slid off the bed and landed face down on the floor. A nurse responded to the care associate’s call for help and found the resident face down on the floor, bleeding from a laceration above the right eyebrow. The resident was assessed, found to have a 2.5 cm laceration on the right forehead, and was transferred to the hospital emergency department, where the wound was repaired with seven sutures. Interviews with the nurse and the care associate confirmed that the care associate was alone in the room at the time of the incident and did not follow the two-person assistance intervention specified in the resident’s care plan and care card.
Failure to Follow Two-Person Assist Requirements During Bed Mobility Resulting in Fall and Head Laceration
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident who required the assistance of two staff members for bathing, dressing, and bed mobility was provided with that level of assistance during care, resulting in a fall and injury. The facility had policies on Fall Management and on Lifting, Transfer and Bed Mobility that required residents to be assessed for mobility needs, have individualized care plans, and have the type and level of assistance (including number of staff required) communicated to staff and reflected in the care plan and care card. For this resident, the care plan and resident care card both specified total dependence with assistance of two staff members for bathing, dressing, and bed mobility. The resident’s MDS assessment documented severe cognitive impairment (BIMS score of 00) and dependence on staff for these ADLs. On the date of the incident, a care associate assigned to the resident provided morning care and repositioning while the resident was in bed. The care associate reported that she turned the resident onto his/her back, put pants on up to the ankles, then turned the resident toward her near the edge of the bed and began to pull up the pants. At that point, the resident slid off the bed and landed face down on the floor. The care associate stated that the resident hit his/her head on the floor and began bleeding from above the right eyebrow. She immediately applied pressure with a towel and called out for help. The nurse on duty heard the call for help, went to the room, and found the resident lying face down on the floor near the bed with profuse bleeding from a laceration above the right eyebrow. The nurse assessed the resident, applied pressure to the laceration, and emergency protocols were initiated, with the resident transferred to the hospital ED. Hospital documentation indicated the resident presented after a fall at the facility with a 2.5 cm laceration to the right forehead that required closure with seven sutures. In interviews, the care associate acknowledged she knew the resident required two staff members for bed mobility and in-bed care but provided care alone and did not request assistance. The nurse and the DON both confirmed that the resident required two-person assistance for bathing, dressing, and bed mobility as indicated on the care plan and care card, and that only one staff member was present in the room at the time of the incident. The DON stated that the care associate did not follow the resident’s care plan, resident care card, or facility policy, leading to the incident in which the resident slid from the bed to the floor and sustained a head laceration. The facility’s Fall Management policy defined a fall as any event resulting in the resident coming to rest unintentionally on the floor or a lower level when found on the floor, and required assessment of residents for fall risk and development of individualized care plans with fall prevention protocols. The Lifting, Transfer and Bed Mobility policy required that bed mobility be assessed as one-person or two-or-more-person assist, and that the type and level of assistance, including number of staff required for bed mobility and transfers, be communicated to staff and reflected in the care plan. Despite these policies and the documented requirement for two-person assistance, the resident was turned and repositioned near the edge of the bed by a single care associate, which directly preceded the resident sliding off the bed and sustaining the injury.
Failure to Timely Report Suspected Abuse to Law Enforcement
Penalty
Summary
On 03/20/25, a resident with Alzheimer's disease, severe cognitive impairment, agitation, and depression reported to a CNA that another CNA had physically abused them during a transfer. The allegation was immediately reported up the chain of command, with the nurse notifying administration the same day. A skin check revealed three small bruises on the resident's right thigh. The facility's investigation led to the suspension and subsequent termination of the accused CNA based on the findings. Despite being aware of the allegation and the facility's policy requiring immediate reporting of suspected abuse to authorities, administration did not notify local law enforcement of the reasonable suspicion of a crime until 04/15/25, the day of the survey. The delay in reporting to law enforcement was contrary to both facility policy and the requirements under the Elder Justice Act, which mandates timely notification to state agencies and law enforcement in cases of suspected abuse.
Medication Storage Deficiency
Penalty
Summary
The facility failed to ensure that all drugs and biologicals were stored securely as required, leading to medications being left unattended in the rooms of six residents. The facility's policy on medication management, which includes proper storage, was not adhered to. Medications were observed on top of locked medication cabinets and in unlocked drawers in residents' rooms, contrary to the facility's policy that requires all prescription medications to be locked in the medication cabinet unless a resident is assessed to self-administer medications. Specific observations included a box of Lidoderm patches in one resident's room, various medications such as Albuterol, Benefiber, and Aspercreme in another, and multiple bottles of Nystatin in a third resident's room. Additionally, medications like guaifenesin and polyethylene glycol were found in unlocked cabinets, and blister packs of mirtazapine and pantoprazole were left on top of medication cabinets. In one instance, a medication cabinet was found unlocked with multiple blister packages and a box of Albuterol inside. The Director of Nurses confirmed that all prescription medications should be locked unless the resident is assessed to self-administer, indicating a lapse in adherence to the facility's medication storage policy.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Hingham
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Queen Anne Nursing Home, Inc | 1.1 mi | ★★★★★ | 0 | 0 |
| Care One At Weymouth | 1.6 mi | ★★★★★ | 11 | 0 |
| Southwood At Norwell Nursing Ctr | 2.5 mi | ★★★★★ | 9 | 0 |
| Dwyer Home | 2.8 mi | ★★★★★ | 3 | 0 |
| Royal Norwell Nursing & Rehabilitation Center Llc | 3.2 mi | ★★★★★ | 10 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.