Merriam Gardens Healthcare & Rehabilitation Center

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents and five Certified Nurse Aides (CNA) were reviewed for yearly performance evaluations and the associated in-service training. Based on record review and interview, the facility failed to ensure three of the five CNA staff reviewed had yearly performance evaluations completed. This placed the residents at risk for inadequate care.

Inspectors wroteThe facility identified a census of 74 residents. The facility had one main kitchen. Based on observation and interview, the facility failed to ensure staff stored food items in accordance with the professional standards for food service safety. This placed residents at risk of foodborne illness and cross-contamination (the transfer of harmful substances to food).

Inspectors wroteThe facility reported a census of 74. The sample included 18 residents. Based on observations, record reviews, and interviews, the facility failed to address and resolve recurring issues reported by the Resident Council. This deficient practice placed the residents at risk for decreased psychosocial well-being. Findings Included- - A review of the facility's Resident Council Minutes from 09/2023 through 09/2024 indicated the council had recurring concerns with the food choices, menus, temperatures, and availability. The minutes also noted concerns related to maintaining and cleaning the shower rooms. The 09/2023 Resident Council Minutes documented concerns that the residents were not getting their showers on time, the food was being served cold, and residents were not being offered options. [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents. Based on observation, record review, and interviews, the facility failed to promote a safe, homelike environment. This deficient practice had the potential for decreased psychosocial well-being and impaired safety and comfort for the affected residents. Findings Included: - On 09/30/24 at 07:01 AM a walkthrough of the facility was completed with the following observation noted: An inspection of the 100-hallway revealed two wedge cushions, a bathroom commode, a walker, and an intravenous (IV) pole in the hall. An inspection of the 200 hallway revealed a shower bed and two wheelchairs stored out in the resident area. An inspection of the 300 hallway revealed a two-step ladder, walker, and wheelchair stored in the resident area. [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 with three reviewed for accidents. Based on observation, record review, and interview the facility failed to secure potentially hazardous cleaning chemicals in a safe, locked area, and out of reach of ten cognitively impaired independently mobile residents. The facility additionally failed to ensure implemented care-planned fall interventions were in place for Resident (R)9 and R73. This placed the affected residents at risk for preventable accidents and injuries. Findings Included: - On 09/30/24 at 07:10 AM an inspection of the 300 hallway revealed a bottle of purple Sani-wipes left unsecured on a table in the television area. The bottle contained the warning, Keep out of reach of children, hazardous to humans can cause eye irritation, harmful if swallowed. [...]

Inspectors wroteThe facility identified a census of 74 residents, two medication rooms, and five medication carts. Based on observation, record review, and interviews, the facility failed to ensure controlled substances were accounted for and reconciled between shifts. This placed the residents at risk for misappropriation and/or diversion of controlled substances.

Inspectors wroteThe facility identified a census of 74 residents. The facility identified one main kitchen and one dining room. Based on observation, record review, and interview the facility failed to ensure dietary staff provided posted menu items to residents when the kitchen ran out of bacon and sausage for the breakfast meal on 09/30/24. This placed residents at risk of nutritional needs and preferences not being met.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with two reviewed for nutritive diets. Based on observation, record review, and interviews, the facility failed to ensure meals were served at a palatable, safe, and appetizing temperature for Residents (R)8, R11, R24, and R27. This deficient practice placed the residents at risk for risks related to impaired nutrition and weight loss. Findings Included: - On 09/30/24 at 07:14 AM R24 sat in the dining room. R24 stated he was waiting for breakfast. He stated the food was often served cold. He stated even the food coming out of the kitchen to the dining room was often served cold. On 09/30/24 at 08:25 AM, R27 sat in his room preparing for breakfast. R27 reported his breakfast was often cold by the time it reached him. A temperature check of his eggs revealed them to be at 90 degrees Fahrenheit. [...]

Inspectors wroteThe facility identified a census of 74 residents. The facility identified 10 residents on Enhanced Barrier Precautions (EBP-infection control interventions designed to reduce transmission of resistant organisms that employ targeted gown and glove use during high contact care). Based on record review, observations, and interviews, the facility failed to implement signage or indicators within the physical environment to alert staff and visitors of the required EBP. The facility additionally failed to follow sanitary infection control practices related to oxygen equipment, laundry services, and wearing personal protective equipment (PPE). These deficient practices placed the residents at risk for infectious diseases. Findings Included: - An initial walkthrough of the facility was completed on 09/30/24 at 07:10 AM to identify signage and PPE for residents on EBP. [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents. Based on record review, interviews, and observations, the facility failed to ensure necessary equipment remained in safe and functional status. This deficient practice placed the residents at risk for impaired quality of life. Findings Included: - A review of the facility's Resident Council Minutes for September 2023 revealed the council reported concerns that the right-side shower room of the [NAME] Hall needed to be fixed. An attached grievance form indicated a plumber assessed the drain and found a broken pipe three feet down in the drain. A review of the Resident Council Minutes for October 2023 again mentioned the need for a plumber related to the shower rooms. The Resident Council Minutes from November 2023 through September 2024 did not mention the out-of-order shower room. [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents. Two residents were sampled for reasonable accommodations of needs. Based on observation, record review, and interview, the facility failed to ensure Resident (R)47 was given a lipped plate and his meat was cut up into bite-size portions. The facility further failed to ensure R50's call light was within her reach. This deficient practice left R47 and R50 vulnerable to unmet care needs.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with three reviewed for Center for Medicare and Medicaid Services (CMS) Beneficiary Liability notices. Based on record review and interviews, the facility failed to provide form CMS-10055, Skilled Nursing Facility (SNF) Advance Beneficiary Notice of Non-coverage (ABN) for Resident (R) 3 and R132. This deficient practice placed these residents at risk for uninformed decisions.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with two sampled residents reviewed for hospitalization. Based on observation, record review, and interviews, the facility failed to provide written notification of transfer to Resident (R) 45 or their representatives for their facility-initiated transfers. The facility also failed to notify to the long-term care ombudsman (LTCO) for R45. This deficient practice had the risk of miscommunication between the facility and resident/family and possible missed opportunities for healthcare service for R45.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with two sampled residents reviewed for hospitalization. Based on observation, record review, and interviews, the facility failed to provide a bed hold policy notice to Resident (R) 45 or their representatives when they transferred to the hospital. This deficient practice had the risk of impaired ability to return to the facility and to his previous room for R45.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents. Based on observation, record review, and interviews, the facility failed to fully complete the annual comprehensive Minimum Data Set (MDS) for Resident (R) 45 by not completing documentation analysis for triggered care areas. This placed this resident at risk for inaccurate reflections of the resident's status and an inaccurate care plan.

Inspectors wroteThe facility reported a census of 74 residents. The sample included 18 residents with two reviewed for activities of daily living (ADLs). Based on records review, interviews, and observations, the facility failed to provide the required ADL assistance for Resident (R)11 for dressing. This deficient practice placed R11 at risk for impaired independence and a loss of ADL function. Findings Including: - The Medical Diagnosis section within R11's Electronic Medical Records (EMR) included diagnoses of altered mental status, cognitive communication deficit, major depressive disorder (major mood disorder), and unsteadiness on his feet. R11s Annual Minimum Data Set (MDS) completed 08/12/24 noted a Brief Interview for Mental Status (BIMS) score of 10 indicating moderate cognitive impairment. The MDS indicated he required supervision or touch assistance for dressing and personal hygiene. [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with one resident reviewed for quality of care. Based on observation, record review, and interviews, the facility failed to follow a physician's order for weight monitoring for fluid overload and further failed to ensure Resident (R) 73's as-needed (PRN) diuretic (a medication used to promote formation and excretion of urine) was administered per orders when needed. This deficient practice placed R73 at risk for fluid overload and related complications.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with one resident reviewed for positioning and mobility. Based on observation, record review, and interviews, the facility failed to ensure Resident (R)47's palm splint was available. This deficient practice placed the resident at risk for discomfort and decreased range of motion (ROM- the full movement potential of a joint, usually its range of flexion and extension).

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with five sample residents reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure the Consultant Pharmacist (CP) identified and reported when Resident (R) 67's blood pressure medication was given outside of the physician-ordered parameter. This placed R67 at risk for unnecessary medication administration and adverse side effects.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with five sampled residents reviewed for unnecessary medications. Based on observation, record review, and interview, the facility failed to ensure Resident (R) 67's blood pressure medication was given within the physician-ordered parameter. This placed R67 at risk for unnecessary medication administration and adverse side effects.

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with two residents reviewed for (a type of health care that focuses on the terminally ill patient's pain and symptoms and attending to their emotional and spiritual needs at the end of life) services. Based on observation, record review, and interview, the facility failed to ensure a coordinated plan of care, which coordinated care and services provided by the facility with the care and services provided by hospice, was developed and available for Resident (R)3. This placed the resident at risk for inappropriate end-of-life care. Finding Included: [...]

Inspectors wroteThe facility identified a census of 74 residents. The sample included 18 residents with five reviewed for immunization status. Based on record reviews, and interviews, the facility failed to administer the Pneumococcal Conjugate Vaccine (PCV20- vaccination for bacterial infections) pneumococcal (type of bacterial infection) vaccination for Resident (R) 10. This placed the residents at increased risk for complications related to pneumonia.

Inspectors wroteThe facility had a census of 75 residents. The sample included 18 residents. Based on observation, record review, and interview, the facility failed to follow-up or resolve resident grievances, placing the residents at risk for unresolved concerns.

Inspectors wroteThe facility had a census of 75 residents. The sample included 18 residents. Based on observation, record review, and interview, the facility failed to prepare and serve their planned menus for 02/13/23 and 2/14/23, due to unavailable food items and failed to update or notify the residents when food items were substituted so they were given the opportunity to change their order on two of the onsite days of the survey . This placed the residents at risk for disappointment and inadequate food intake.

Inspectors wroteThe facility had a census of 75 residents. The sample included 18 residents. Based on observation, record review, and interview the facility failed to distribute and serve food in accordance with professional standards for food service safety and the prevention of food borne illness, for the 68 residents who resided in the facility and received their food from the facility kitchen when the facility failed to ensure clean and sanitary food prep and storage areas, and when staff failed to provide a room tray at the proper temperature for Resident (R) 38. This placed the residents at risk for foodborne illness.

Inspectors wroteThe facility had a census of 75 residents. The sample included 18 residents. Based on observations, record review, and interview, the facility failed to update two resident care plans, Resident (R) 58 for falls and R63 for a Foley catheter (tube inserted directly into the bladder to drain urine). This placed the resident's at risk for unmet needs and cares.

Inspectors wroteThe facility had a census of 75 residents. The sample included 18 residents, with five reviewed for accidents. Based on observation, record review, and interview, the facility failed to idenitfy and implement appropriate, resident-centered interventions for Resident (R) 58, who had multiple falls. This placed the resident at risk for further falls.

Inspectors wrote- The Electronic Medical Record (EMR) for R58 documented diagnosis of hypertension (high blood pressure), congestive heart failure (a condition with low heart output and the body becomes congested with fluid), unsteadiness on feet, disorientation (loss of direction), and edema (puffiness caused by excess fluid trapped in the body's tissue. The Quarterly Minimum Data Set (MDS), dated [DATE], documented R58 had severely impaired cognition and required extensive assistance of one staff for bed mobility, transfers, dressing, toileting, and limited assistance of one staff for ambulation. The assessment further documented R58 was frequently incontinent of bladder and bowel. The Care Plan, dated 01/19/23, directed staff to establish voiding patterns, offer toileting upon rising, before and after meals, before lying down and assist when she voiced the urge to use the bathroom. [...]

Inspectors wroteThe facility had a census of 75 residents. The sample included 18 residents, with one reviewed for hydration. Based on observation, record review, and interview, the facility failed to adequately monitor and ensure staff were aware that Resident (R) 27 was on a 1500 milliliter (ml) daily physician ordered fluid restriction so they could educate the resident and update the providers on his fluid consumption. This placed the resident at risk for fluid overload.

Inspectors wroteThe facility had a census of 75. The sample included 18 residents of which one was reviewed for respiratory care. Based on observation, record review, and interview, the facility staff failed to provide cares that included checking oxygen amounts in portable oxygen canister for Resident (R) 5. This placed the R5 at risk for running out of oxygen causing respiratory distress (severe shortness of breath).

Inspectors wroteThe facility had a census of 63 residents. Based on observations, record review, and interview, the facility failed to routinely monitor the food temperatures on the steam table for the 61 residents who received meals from the facility kitchen.

Inspectors wroteThe facility had a census of 63 residents. Based on observations, record review, and interview, the facility failed to provide a certified dietary manager to carry out the functions of food and nutritional services for the 61 residents who resided in the facility and received meals from the facility kitchen.

Inspectors wroteThe facility had a census of 63 residents. Based on observations, record review, and interview, the facility failed to prepare, store, and serve meals under sanitary conditions for the 61 residents who received meals from the facility kitchen.

Inspectors wroteThe facility had a census of 63 residents. Based on observation, record review, and interview, the facility failed to provide a safe environment for the 15 cognitively impaired, independently mobile residents in the facility.

Inspectors wroteThe facility had a census of 63 residents. The sample included 16 residents with six reviewed for unnecessary medications. Based on interview, observation, and record review, the facility failed to ensure an appropriate diagnosis for Resident (R) 20 and R34's Seroquel (antipsychotic medication).

Inspectors wroteThe facility had a census of 63 residents. The sample included 16 residents. Based on observation, record review, and interview the facility failed to prevent the development of communicable diseases and infections for two of 19 residents who received blood glucose testing (a blood sample test which measures the amount of sugar in the blood), Resident (R) 20, and R35.