Merit House LLC

Inspectors wroteBased on medical record review, observation, interview, and policy review, the facility failed to ensure residents had a functioning call system. This affected 18 (Resident #7,#13,#19,#15,#10,#26,#43,#32,#6,#4,#63,#57,#64,#33,#73,#5,#14,#31) out of 18 residents who resided on the 400 and 500 hallway. Additionally, the facility failed to provide timely care to residents who did not have a functioning call system. This affected one (Resident #33) of three reviewed for timely care. The facility census was 73. Findings Included:1. Review of the medical record for Resident #33 revealed an admission on [DATE]. Diagnoses included cerebral infarction, muscle spasms of back, and muscle weakness. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed this resident had impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 05. [...]

Inspectors wroteTHE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY.Based on review of electronic mail (email) correspondence, staff interview and review of the facility investigation, the facility failed to ensure Minimum Data Set (MDS) assessments were certified by qualified staff. This affected 40 (#43, #66, #74, #63, #75, #44, #77, #15, #80, #81, #82, #83, #84, #85, #86, #87, #88, #89, #90, #91, #92, #93, #94, #95, #96, #97, #98, #99, #100, #101, #102, #103, #104, #105, #106, #107, #108, #109, #110, and #111) residents identified by the facility as having MDS assessments completed by an unqualified staff. The facility census was 78.

Inspectors wroteBased on observation, staff interview, personnel file review, and policy review revealed the facility failed to ensure personnel obtained the proper registry. This affected one (#101) of four Certified Nursing Assistant personnel files reviewed. This had the ability to affect all residents. The facility census was 84.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to ensure narcotic pain medications were administered as ordered. This affected one (#11) of three residents reviewed for narcotic pain medication use. The facility census was 84.

Inspectors wroteBased on observation, medical record review, resident interview, and staff interview the facility failed to ensure residents were transported to appointments as scheduled. This affected one (#11) of three residents reviewed for transportation to outside appointments. The facility census was 84.

Inspectors wroteBased on observation, staff interview, and review of a facility policy, the facility failed to ensure medications were stored in a safe and secure manner. This had the potential to affect all 81 residents residing in the facility. The facility census was 81.

Inspectors wroteBased on resident interview, medical record review, staff interview and review of facility policy, the facility failed to ensure residents were provided opportunities and assistance with voting. This affected three (#4, #7 and #47) of three residents reviewed for voting, with the potential to affect all residents except one (#69) identified by the facility as voting by absentee ballot. The facility census was 91.

Inspectors wroteBased on observation, staff interview and review of facility policy, the facility failed to maintain a dignified dining experience for the residents by serving meals on disposable dishware. This had the potential to affect 79 of 81 residents who received meals from the kitchen. The facility identified two residents (#2 and #34) who received no food from the kitchen. The facility census was 81.

Inspectors wroteBased on observation, staff interview, review of the facility menu and review of facility policy, the facility failed to follow established menus and further failed to maintain a substitution log. This had the potential to affect 79 of 81 residents who received food from the kitchen. The facility identified two residents (#2 and #34) who received no nutrition from the kitchen. The facility census was 81.

Inspectors wroteBased on resident interview, observation, medical record review, staff interview and review of facility policy, the facility failed to complete dressing changes according to physician orders. This affected one (#30) of three residents reviewed for wound care. The facility census was 81.

Inspectors wroteBased on observation, resident interview, medical record review, staff interview and review of facility policy, the facility failed to obtain a physician order for administration of oxygen therapy. This affected one (#30) of three residents reviewed for oxygen therapy. The facility identified 18 residents who received oxygen therapy. The facility census was 81.

Inspectors wroteBased on observation, medical record review, staff interview, review of the emergency medication box (E-box) inventory and review of facility policy, the facility failed to administer medications per physician order. This affected one (#100) of three residents reviewed for medication administration. The facility census was 81.

Inspectors wroteBased on observation, staff interview and review of the facility policy, the facility failed to ensure soiled bedpans were cleaned and disinfected timely. This affected one (#22) of one resident reviewed for bedpan use. The facility identified eight additional residents who utilized bedpans. The facility census was 81.

Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to ensure medications were administered as ordered. This affected one (#93) of three residents reviewed for medications. The facility census was 83.

Inspectors wroteBased on record review, staff interview, review of exterminator documents, and policy review, the facility failed maintain a pest free environment. This affected one (#84) of two residents reviewed for environmental concerns. The facility census was 83.

Inspectors wroteBased on medical record review, staff interview, review of facility Self-Reported Incidents (SRIs), review of staff schedules, and review of the facility policy, the facility failed to thoroughly investigate an allegation of verbal abuse and failed to protect residents from potential abuse. This affected three (Resident #9, #42, and #54) of three residents reviewed for abuse. The facility census was 85.

Inspectors wroteBased on observation, review of a facility investigation, staff interview, and policy review, the facility failed to maintain a safe environment free from an outdoor fire. This had the potential to affect 11 residents (#5, #9, #14, #34, #38, #42, #46, #54, #61, #77, #181) with rooms in proximity to where the fire occurred. The facility census was 85.

Inspectors wroteBased on medical record review, observation, resident interview, and staff interview, the facility failed to ensure residents received the necessary services to maintain a dignified appearance. This affected one (Resident #62) of three residents reviewed for dignity. The facility census was 85.

Inspectors wrote2. Review of the medical record revealed Resident #182 was admitted to the facility on [DATE]. Diagnoses included chronic destructive pulmonary disease, asthma, and heart failure. Review of the admission MDS assessment dated [DATE] revealed Resident #182 was cognitively intact. The resident required partial to moderate assistance from staff for bed mobility. Review of the physician orders for September 2024 identified an active order dated 09/05/24 for top bilateral siderails to aide in bed mobility and promote independence. Review of the plan of care dated 09/07/24 identified Resident #182 was at risk for an activities of daily living self-care performance deficit related to limited mobility. Interventions included half rails up as per physician orders for safety during care provision, to assist with bed mobility, and to observe for injury or entrapment related to siderail use. [...]

Inspectors wroteBased on medical record review, staff interview and facility policy review, the facility failed to notify the physician of resident weight loss. This affected one (Resident #48) of three residents reviewed for nutrition. The facility census was 85.

Inspectors wroteBased on observation, resident interview, and staff interview, the facility failed to provide a clean, comfortable, and homelike environment. This affected one (Resident #19) of one resident observed for room cleanliness. The facility census was 85.

Inspectors wroteBased on medical record review, staff interview, review of facility Self-Reported Incidents (SRIs), and review of the facility policy, the facility failed to report an allegation of verbal abuse to the state agency in a timely manner. This affected three (Resident #9, #42, and #54) of three residents reviewed for abuse. The facility census was 85.

Inspectors wroteBased on medical record review, observation, resident interview, and staff interview, the facility failed to ensure admission orders were obtained to provide care and treatment to a resident with a surgical incision. This affected one (#178) of one resident identified with a surgical incision. The facility census was 85.

Inspectors wroteBased on observation, medical record review, review of facility policy, staff interview, and resident interview, the facility failed to provide grooming services for a resident. This affected one resident (Resident #20) of three residents observed for ADLs. The facility census was 85.

Inspectors wroteBased on medical record review, staff interview and policy review, the facility failed to assist with vision services in a timely manner. This affected two (#32, #46) of two residents reviewed for vision services. The facility census was 85.

Inspectors wroteBased on medical record review, observation, resident interview, and staff interview, the facility failed to ensure dietary supplements were administered per the physician's order. This affected one (#48) of three residents reviewed for nutrition. The facility census was 85.

Inspectors wroteBased on review of the medical record, review of physician orders, review of medication administration records, staff interview, and policy review, the facility failed to ensure medications were administered per physician orders. This affected one (#77) of six residents reviewed for medications. The facility census was 85.

Inspectors wroteBased on observation, medical record review, staff interview, and policy review, the facility failed to ensure medications were administered in accordance with physician orders resulting in a medication error rate of five percent. 37 medications were observed with two medication errors, resulting in a medication error rate of five percent. This affected one (#17) of two residents reviewed for medication administration. The facility census was 85.

Inspectors wroteBased on observation, facility policy review, and staff interview, the facility failed to utilize proper Personal Protective Equipment (PPE) for a resident positive for COVID-19. This affected one (Resident #4) of one resident observed for COVID-19 precautions. The facility census was 85.

Inspectors wroteBased on review of facility electronic medical record, staff interview, and review of facility policy, the facility failed to residents were educated on and received the COVID-19 vaccination. This affected two residents (Resident #332 and Resident #46) of five residents reviewed. The facility census was 85.

Inspectors wroteBased on record review and interview, the facility failed to complete a performance review of every nurse aide at least once every 12 months. This affected two State Tested Nursing Assistants (STNAs #402 and #475) of four STNAs reviewed. This had the potential to affect all residents residing in the facility. The facility census was 85.

Inspectors wroteBased on observation, staff interview, and review of facility policies, the facility failed to manage soiled and clean linen to potentially prevent cross-contamination. This had the potential to affect 54 of 54 residents who utilized laundry services at the facility. The facility census was 54.

Inspectors wroteBased on medical record reviews, staff and resident interviews, and policy review, the facility failed to allow residents to make their own choices related to food options at meals. This affected five (#14, #28, #31, #40 and #45) of five residents interviewed and expressed concerns over the lack of food choices being offered. The census was 54.

Inspectors wroteBased on review of the resident trust account balances, review of the surety bond, and staff interview, the facility failed to ensure the surety bond was sufficient to cover the total of resident trust accounts held at the facility. This affected 30 (#1, #3, #4, #6, #7, #8, #10, #13, #14, #16, #17, #18, #20, #21, #22, #23, #25, #28, #29, #30, #31, #35, #38, #40, #43, #44, #45, #48, and #49) of 30 residents identified by the facility as having a resident trust account. The facility census was 54.

Inspectors wroteBased on observation, resident and staff interview, medical record review, and review of a wheelchair cleaning schedule, the facility failed to ensure wheelchairs were maintained in a safe and comfortable manner. This affected one (#16) of three reviewed for environmental concerns. The facility identified 36 residents who utilized wheelchairs. The census was 54.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to complete a significant change in status assessment. This affected one (#29) of 17 residents reviewed for assessments. The facility census was 54.

Inspectors wroteBased on medical record review, staff interview, and review of policy, the facility failed to revise resident's comprehensive care plans to accurately reflect services provided. This affected two (#29 and #26) of 17 residents reviewed for care plans.

Inspectors wroteBased on observation, medical record review, family and staff interviews, and review of policy, the facility failed to provide nail care to residents dependent for care. This affected one (#35) of 17 residents reviewed for activities of daily living. The facility census was 54. Finidngs include: Review of the medical record for Resident #35 revealed an admission date of 12/17/15. Diagnoses included dementia, heart failure, acute respiratory failure, chronic obstructive pulmonary disease (COPD), kidney disease, schizoaffective disorder, heart disease, anxiety disorder, bipolar disorder, and major depressive disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #35 was moderately cognitively impaired and required extensive assistance with personal hygiene. [...]

Inspectors wroteBased on record review, observation, resident interview, staff interview, and review of job description, the facility failed to ensure clothing other than hospital gowns were obtained for daily wear for one (#140) out of one resident reviewed for choices. The facility census was 49.

Inspectors wroteBased on medical record review, observation, resident interview, staff interview, and facility policy review, the facility failed to ensure the call light was within reach for two (#34 and #4) of 42 residents identified by the facility to utilize call lights. The facility census was 49.

Inspectors wroteBased on medical record review and staff interview, the facility failed to provide residents and their representative(s) with written notice of the reason for the discharge to three (#37, #39 and #28) of three residents reviewed for hospitalization. The facility census was 49.

Inspectors wroteBased on record review, resident interview, staff interview and review of the care conference documentation, the facility failed to hold care conferences with resident input for one (#2) out of three residents reviewed for care plan participation. The facility census was 49.

Inspectors wroteBased on medical record review, observation, resident interview, staff interview, and facility policy review, the facility failed to address the use of signage to inform the public of a communicable disease requiring isolation and failed to provide signage for isolation for one resident (#19) of one resident reviewed for isolation. The facility identified one resident in the facility in isolation. The facility census was 49.