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Nursing HomeMedicaid Investigative

Rose Garden Nursing and Rehabilitation Center

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

1579 Old Freehold Road, Toms River · Toms River, NJ 08753128 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
4.1/5

based on 74 Google reviews

5
4
3
2
1
Rose Garden Nursing and Rehabilitation Center Nursing Home in Toms River, NJ — Street View
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6/ 10
high Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Abuse citation on record
  • Low overall rating (2/5 stars)
  • Low staffing rating (2/5 stars)
  • Above-median deficiencies (14 vs median 7)

Bottom 25% in NJ · Below recommended RN staffing · $17,345 in fines · Abuse citation

Source: Medicare data

What this means for your family

Rose Garden is highly regarded for its physical therapy and clean, engaging environment, making it a strong contender for many families. However, because multiple reviewers have reported issues with staffing levels and administrative responsiveness, we strongly recommend you visit during off-hours or weekends to observe the care firsthand and ask specific questions about their nurse-to-patient ratios.

Google Reviews

Google Reviews

74 reviews on Google
Rose Garden Nursing and Rehabilitation Center receives high praise from many families for its attentive nursing staff, clean environment, and effective physical therapy programs. However, a segment of reviewers reports serious concerns regarding inconsistent care, communication breakdowns, and issues with discharge planning or administrative responsiveness. Families should be aware that while many have positive long-term experiences, there are recurring reports of neglect and staffing shortages that have deeply impacted some residents.

Quality Themes

Tap a score for details
Food9.0Staff7.0Clean9.0Activities9.0Meds7.0Memory7.0Comms6.0Value5.0

Strengths

  • Attentive and caring nursing and CNA staff
  • Effective physical and occupational therapy programs
  • Clean and well-maintained facility
  • Engaging activities and recreation staff
  • Accessible and responsive administration

Concerns

  • Inconsistent nursing care and staffing shortages (mentioned by 6 reviewers)
  • Poor communication and lack of administrative responsiveness (mentioned by 4 reviewers)
  • Issues with discharge planning and patient safety (mentioned by 3 reviewers)
  • Loss of personal property (e.g., hearing aids) (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

234'15(2)'18(5)'20(15)'22(11)'24(12)'26(4)

Distribution · 77 analyzed

5
57
4
4
3
0
2
3
1
13

How They Respond to Reviews

27%response rate

This facility rarely responds to reviews.

Questions for Your Tour

  • 1We've heard wonderful things about your therapy programs; could you tell us more about how the physical and occupational therapists work with residents on their recovery goals?
  • 2What specific steps does the nursing team take to ensure consistent care and communication between the CNAs and the families during shift changes?
  • 3How does the administration ensure that all personal items, like hearing aids or glasses, are safely tracked and accounted for during daily care?
  • 4Can you describe the types of social activities or recreational programs available to help residents stay engaged and connected with others?
  • 5In the event of a medical emergency after hours, what is the protocol for notifying the family and ensuring immediate physician oversight?
  • 6We noticed the facility is very well-maintained; how does the staff ensure that the cleanliness of the resident rooms is prioritized alongside daily medical care?

Personalized based on this facility's data


Key Review Excerpts

My mom, Jane, was at another facility due age and demensia, that left her fastly declining and in a wheel chair. With persistent follow up over months, a room became available at Rose Garden. We jumped on the opportunity. Staff was attentive to my mother's needs.

Memory care family member · 2025★★★★★

My Mom had been receiving sub par care at another Sub Acute Rehab after a fall and hospital stay! Luckily, I was able to transfer Mom to Rose Garden!! I, along with all of my siblings live/work out of State so I had a huge sigh of relief to know she was now in good hands!

Long-term resident's family · 2025★★★★★

My mother tried to stand up, fell, hit her head, & broke her false teeth. She suffered a subdural hematoma, as well as stitches. The reason I was given, was that Rose Garden did not have enough staff to supervise someone like my mother one-on-one.

Rehab patient's family · 2017☆☆☆☆
Source: 74 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.52hrs
70%
Registered nurses for medical care
Total Nursing
3.43hrs
84%
All nurses + aides combined
Staff Turnover
46%
Lower is better (< 30% = good)
RN Turnover
47%
Lower is better (< 30% = good)

Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
4/ 5
Better Than Avg

12

measures

Worse Than Avg

4

measures

Mixed Results

1

measures

Long-Stay Residents
🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility6.0%
Better than Avg
Here
6.0%
US
19.4%
NJ
15.7%
Ocean
19.0%
😔

Residents with depression symptoms

↓ Lower is better
This Facility0.6%
Better than Avg
Here
0.6%
US
12.1%
NJ
11.7%
Ocean
11.6%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
93.4%
NJ
93.0%
Ocean
89.2%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility4.8%
Better than Avg
Here
4.8%
US
15.3%
NJ
9.1%
Ocean
8.5%
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility4.9%
Better than Avg
Here
4.9%
US
14.4%
NJ
9.2%
Ocean
8.0%
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility24.9%
Worse than Avg
Here
24.9%
US
19.5%
NJ
18.9%
Ocean
22.6%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility97.9%
Better than Avg
Here
97.9%
US
81.8%
NJ
78.7%
Ocean
69.7%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility99.0%
Better than Avg
Here
99.0%
US
79.7%
NJ
80.1%
Ocean
74.9%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.4%
Better than Avg
Here
0.4%
US
1.6%
NJ
1.2%
Ocean
1.1%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

14deficiencies
1penalties
Well above state avg (8.5)
1 complaint-triggered
$17,345 in fines

A serious abuse allegation triggered a complaint investigation at this facility, and families have filed reports with federal regulators. Rose Garden shows recurring problems with infection control, food safety, and care planning across multiple surveys from 2022 to 2025. While the facility has corrected past violations, the pattern of repeated issues in core care areas—particularly the recent serious abuse finding—raises significant concerns about resident safety and quality of care.

Oct 31, 2025Complaint
1
0600Immediate jeopardy · IsolatedResolved (past non-compliance)

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Sep 18, 2025Routine
19
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0521Potential for harm · WidespreadCorrected

Services Deficiencies

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

0531Potential for harm · WidespreadCorrected

Services Deficiencies

Have elevators that firefighters can control in the event of a fire.

0741Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

0761Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

0914Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.

0921Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure that testing and maintenance of electrical equipment is performed.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0605Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

0641Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

0656Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

0657Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

0689Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

0744Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

0868Potential for harm · IsolatedCorrected

Administration Deficiencies

Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

0881Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Implement a program that monitors antibiotic use.

0882Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

0883Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Develop and implement policies and procedures for flu and pneumonia vaccinations.

May 8, 2024Routine
11
0725Potential for harm · WidespreadCorrected

Nursing and Physician Services Deficiencies

Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

0004Potential for harm · WidespreadCorrected

Emergency Preparedness Deficiencies

Develop and maintain an Emergency Preparedness Program (EP).

0345Potential for harm · WidespreadCorrected

Smoke Deficiencies

Have approved installation, maintenance and testing program for fire alarm systems.

0812Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0918Potential for harm · PatternCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0582Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

0658Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure services provided by the nursing facility meet professional standards of quality.

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0355Potential for harm · IsolatedCorrected

Smoke Deficiencies

Properly select, install, inspect, or maintain portable fire extinguishes.

0761Potential for harm · IsolatedCorrected

Miscellaneous Deficiencies

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

Jan 3, 2022Routine
2
0812Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0341Potential for harm · PatternCorrected

Smoke Deficiencies

Install a fire alarm system that can be heard throughout the facility.

Federal Penalties

Fine

Sep 18, 2025

$17,345

Ownership & Operations

Who Operates This Facility

Owner / Operator

Rose Garden Nursing and Rehabilitation Center

Organization Type

for profit

Ownership & Management

Owners

Shawn, Andrew

Owner

Key personnel

Shawn, AndrewOfficer / DirectorShawn, AndrewManagerShawn, AndrewGeneral Partnership InterestShawn, AndrewAdp of the Snf
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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