Meeker Manor Rehablitation Center, LLC

Inspectors wroteBased on interview and record review, the facility failed to ensure an interdisciplinary team (IDT) assessment was completed to determine whether self-administration of medication was clinically appropriate and safe prior to permitting self-administration of nebulizer treatments, for 1 of 1 resident (R1) reviewed for self-administration of medications.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents receiving psychotropic medications were adequately assessed and monitored. Further the facility failed to initiate target behavior monitoring for 1 of 5 residents (R3) reviewed for unnecessary psychotropic medications.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement comprehensive, person-centered care plans to address significant medical conditions and medication-related risks, including failure to care plan anticoagulant therapy for 2 of 2 residents (R1 and R3) reviewed for anticoagulant medications, and failure to care plan cardiac conditions, pacemaker presence, and condom catheter use for 1 of 2 residents (R1) reviewed for cardiac care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received routine bathing and grooming services necessary to maintain personal hygiene and dignity, including failure to provide scheduled weekly bathing and failure to assist with facial hair grooming for 2 of 6 residents (R2 and R21) reviewed for activities of daily living (ADL) care.

Inspectors wroteBased on interview and record review, the facility failed to ensure appropriate care and services were provided for the management of an external urinary catheter system, including failure to obtain physician orders and implement care instructions for cleaning, disinfecting, and changing the condom catheter drainage bag for 1 of 1 resident (R1) reviewed for urinary catheter care.

Inspectors wroteBased on interview and document review, the facility failed to clarify R5's oxygen (O2) order, reconcile the O2 order, and administer O2 as ordered for 1 of 1 (R5) resident reviewed for oxygen therapy.

Inspectors wroteBased on interview and document review, the facility failed to ensure adequate supply of medication was obtained and administered as ordered for 1 of 3 sampled residents (R1) reviewed for pharmacy services.

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide sufficient staffing to ensure residents received the care and assistance they needed in a timely manner for 3 of 4 residents (R1, R2, R4) reviewed for staffing.

Inspectors wroteBased on document review, interview and observation, the facility failed to implement proper infection control when two nursing assistants were observed not following enhanced barrier precautions or hand hygiene during direct care for 3 of 5 (R2, R4, R5) residents reviewed for infection prevention.

Inspectors wroteBased on observation, interview and document review, the facility failed to include the resident representative in development and implementation of the plan of care for one of one residents (R1) reviewed for residents rights. R1's quarterly minimum data set (MDS) dated [DATE], included R1 had moderate cognitive impairment and diagnoses of traumatic brain injury, stroke, and hemiplegia and hemiparesis (weakness or partial paralysis on one side of the body). R1's face sheet dated 8/28/25, included a contact for family member (FM)-A with the contact type of A/R Responsible Party and POA (power of attorney) Care. On 8/27/25 at 1:10 p.m., R1 was observed sitting in her power wheelchair with feet resting uncovered. Bilateral great toes (both big toes) were noted to have dark red, scab like appearance at base of toenail. No redness or drainage noted. [...]

Inspectors wroteBased on interview and document review, the facility failed to provide timely notification to a provider for a change in condition related to low blood pressures for 1 of 1 resident (R2) who received dialysis and was already hypotensive.

Inspectors wroteBased on interview and document review the facility failed to report to the state agency (SA) for 3 of 3 residents (R3, R5 and R6) reviewed when R3, R5, R6 were named in an external complaint of alleged abuse by facility staff and no report was made within two hours.

Inspectors wroteBased on interview and document review the facility failed to thoroughly investigate and protect residents for an allegation of abuse for 3 of 3 residents (R3, R5 and R6) when the facility received an external, anonymous email alleging allegations of abuse by facility staff.

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide needed care and services to 3 of 3 residents (R2, R4, R5) whose changes in health status were not adequately assessed and physician's orders and treatments were not administered.

Inspectors wroteBased on interview, and record review, the facility failed ensure ongoing commuication and collaboration with dialysis services for 1 of 1 resident (R2) who had orders not implemented.

Inspectors wroteBased on observation, interview and document review, the facility failed to consistently track and monitor dishwasher temperatures for both the wash and rinse cycles, and take timely action to correct the temperatures for 1 of 1 dishwasher observed. The facility also failed to consistently date fresh and frozen items at the time they are opened, or placed into a container, and failed to remove items which were beyond the acceptable date of use from the refrigerator. The facility failed to consistently verify temperatures were within the desired range in the refrigerators and freezers to assure food integrity. In addition, food temperature monitoring lacked consistency of completion following food preparation and prior to serving. This had the potential to affect all 50 current residents, as well as staff and visitors, who ate food served from the kitchen.

Inspectors wroteBased on observation and interview, the facility failed to identify presence of over the counter medications in resident room for 1 of 1 residents (R30) observed to have medications in their room. The medication lacked orders from the medical provider for use, as well as assessment for proper storage and and self administration of medication. In addition, the facility failed to ensure an assessment was completed to determine safe medication administration for 1 of 1 resident (R15) observed to self administer medication through a nebulizer (breathing treatment).

Inspectors wroteBased on observation, interview and record review, the facility failed to address resident requests for further therapy evaluation for 3 of 3 residents (R30, R1, and R212) reviewed for choices.

Inspectors wroteBased on observation, interview, and document review, the facility failed to meet the oral health needs for 1 of 1 resident (R5) reviewed for routine dental services. R5's quarterly Minimum Data Set (MDS) dated [DATE], identified an admission date of 10/22/24, R5 had intact cognition, diagnoses of heart failure, chronic kidney disease and limitation of activities of daily living due to disability. R5's oral/dental evaluation dated 1/21/25, identified R5's teeth were observed to have plaque or debris in localized areas between teeth with several teeth missing and staff would assist with setting up dental appointments and transportation. During observation on 3/3/25 at 2:56 p.m., R5's teeth had a significant amount of built up white/grey debris on her front teeth and several missing teeth on her upper left side. R5 denied pain or difficulty with eating. [...]

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain sanitary conditions for mechanical lifts for 6 of 6 residents (R35, R47, R9, R27, R3, R2) who used a mechanical lift for transfers. This had the potential to affect other residents who used a mechanical lift for transfers. In addition, the facility failed to ensure hand hygiene while providing personal cares to prevent the spread of infections for 2 of 2 residents (R3, R9) observed during personal cares.

Inspectors wroteBased on interview and document review, the facility failed to ensure 1 of 5 residents (R5) reviewed for immunizations were offered and/or provided the pneumococcal vaccination series as recommended by the Centers for Disease Control (CDC) to help reduce the risk of associated infection(s).

Inspectors wroteBased on observation, interview and document review, the facility failed to consistently post the current daily nurse staff posting. This had the potential to affect all 50 current residents, their families and visitors.

Inspectors wroteBased on observation, interview, and document review the facility failed to identify heat register as safety hazard for 1 of 1 resident's (R1) bed that was too close to the heat who had a history of sleeping with his legs off the bed. This deficient practice resulted in an immediate jeopardy (IJ) for R1. The IJ began on 3/1/24, when the facility failed to ensure R1's bed was a safe distance from the heat source, R1 was found with is left foot on top of the heater which resulted in multiple second degree burns to the foot and required admission to hospital burn unit for treatment. The administrator and director of nursing (DON) were notified of the IJ on 3/6/24 at 4:51 p.m. The facility implemented corrective action and the deficient practice was corrected on 3/1/24, prior to the survey and was issued at past non-compliance.

Inspectors wroteBased on observation, interview and document review, the facility failed to provide access to sweetener for meals in accordance with resident's wishes for 1 of 1 residents (R3) reviewed for choices.

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide diabetic wound care as ordered for 1 of 2 residents (R36) reviewed for pressure ulcers.

Inspectors wroteBased on observation, interview, and document review, the facility failed to follow proper infection control practices during diabetic wound care for 1 of 2 residents (R36) reviewed for wound care.

Inspectors wroteBased on interview and document review, the facility failed to ensure 1 of 5 residents (R3) reviewed for immunizations were offered and/or provided the pneumococcal vaccine series as recommended by the Center for Disease Control (CDC) to help reduce the risk of associated infection(s).

Inspectors wroteBased on observation, interview and document review, the facility failed to consistently include the facility census on the daily nurse staff posting. This had the potential to affect all 51 current residents, their families, and visitors.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure a comprehensive and individualized care plan was implemented for 1 of 2 residents (R2) reviewed for falls.