The Meridian

Inspectors wroteBased on interviews and record review, the facility failed to ensure resident assessments were electronically transmitted with MDS data to the CMS System for discharge return not anticipated for 2 of 32 residents (CR #1 & 58) reviewed for encoding and transmitting resident assessments. - The facility failed to submit/transmit/export a Return Not Anticipated MDS for CR #1- within the required timeframe. - The facility failed to submit/transmit/export a Return Not Anticipated MDS for CR #58 within the required timeframe. This failure could place discharged residents at risk of not receiving proper Medicaid benefits after discharge and of not having their assessments transmitted/exported timely.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that each resident received an accurate assessment, reflective of the resident's status at the time of the assessment, for ---2 of 16 (Resident #19 and #47) residents reviewed for MDS accuracy. -Resident #19 was not assessed for her lack of natural teeth on her oral cavity. -Resident #47's admission assessment did not reflect his cognition and his lack of natural teeth on his oral cavity. These failures could place residents at risk for not receiving care and services to meet their needs, for diminished function of health, and for regressions in their overall health.

Inspectors wroteBased on observations, interviews and record reviews the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment for 1 of 16 resident reviewed for care plan accuracy (Resident # 27). --Resident # 27's care plan was not revised to reflect a healed deep tissue injury. This failure placed residents at risk of not receiving care according to their individual needs.

Inspectors wroteBased on record review and interviews, the facility failed to ensure completion of a discharge summary including a recapitulation of the resident's stay, final status at discharge and a reconciliation of medications for 1 resident of 1 resident (CR #64) reviewed for discharge summary. The closed record for Resident #64 that was reviewed did not contain a discharge summary that included a recapitulation of the resident's stay. This failure could place residents at risk of not receiving needed care and services after discharge.

Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure each resident's drug regimen was free from unnecessary medications for 1 of 9 residents (Resident #38) reviewed for unnecessary medications. in that: -The facility failed to ensure Resident that Resident #38 did not have an appropriate diagnosis associated with the use of Abilifya and his clinical record did not contain a diagnosis beyond the diagnosis on the consent which was identified as psychotic behavior. This failure could place residents at risk for adverse drug reactions (unintended, harmful events attributed to the use of medicines) and receiving unnecessary medications.

Inspectors wroteBased on observations, interviews, and record review the facility failed to provide a safe, functional, sanitary, comfortable environment for 1 resident of 37 (Resident #11), staff and visitors in 1 resident room (room [ROOM NUMBER] W). Resident #11's room [ROOM NUMBER] had 2 unsecured oxygen tanks standing next to each other on the floor. This failure could place residents, staff, and visitors at risk of living and working in an unsafe, dangerous environment.

Inspectors wroteBased on interviews and record review, the facility failed to establish and follow written policy on permitting residents to return to the facility after they were hospitalized for one (CR #1) of one resident reviewed for transfer/discharge. The facility failed to readmit CR#1 to the facility after she was sent to the hospital on [DATE]. This deficient practice could place residents at risk of being discharged and not allowed to return to the facility, causing a disruption in their care and services and potential decline in health.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the comprehensive care plans were reviewed and revised by the Interdisciplinary team after each assessment for 2 of 13 residents reviewed for care plan accuracy (Residents # 15, #27). --Resident # 15's clinical chart did not contain a care plan for ADL assistance and had care plans for a healed stage 3 sacral ulcer and a healed sore on her great toe. --Resident #27's was care planned for wander guard for risk of elopement, which had been removed by facility

Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored securely in locked compartments for two (Nurse Medication Cart Second Floor and Medication Aide Medication Cart Third Floor) of six medication carts observed for storage of medications. The facility failed to ensure the Nurse medication cart second floor and Medication Aide medication cart third cart were secured when unattended. These failures could place residents at risk for loss of prescribed medications, resident's safety, and drug diversion.

Inspectors wroteBased on observation, interview and record review, the facility failed to coordinate an assessment with Pre-admission Screening and Resident Review program (PASRR) under Medicaid and initiate services within 30 days after the date that the services are agreed upon in the IDT meeting, to ensure that individuals with mental illness or intellectual developmental disabilities receive the care and services they need in the most appropriate setting for 1 of 3 residents (Resident #44) reviewed for pre-admission screenings. -The facility failed to submit a Form 1018, Request for a Customized Manual Wheelchair (CMCW) within 30 days of the date that the services were agreed upon in an IDT meeting addressing Resident #44's needs. This failure could place 2 other residents requiring PASRR services at risk of them not having their special needs assessed and met by the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure that a resident who was incontinent of bowel received appropriate treatment and services to prevent fecal impaction for 1of 33 residents (CR # 62) reviewed for incontinent bowel care in that: The facility failed to ensure CR #62 did not develop bowel complications while at the facility that resulted in hospitalization and a fecal impaction. This failure could place residents at risk for developing bowel complications including impaction and hospitalization.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that the facility provided pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 out of 14 residents (Resident #110) reviewed for pharmacy services. The facility failed to ensure that Resident #110's Hydromorphine (Dilaudid) pain medication was ordered from the pharmacy and received timely. This failure could place residents whose medications were supervised by the facility at risk of experiencing serious side effects from possible interruptions to their medication regimen. Findings Included: Record review of Resident #110's face sheet revealed she was a [AGE] year old female who was admitted to the facility on [DATE]. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete and transmit a resident assessment within the required time frame for 1 of 33 residents (CR#1) reviewed for data completion and transmission in that: - CR #1's did not have a Discharge MDS completed within the required timeframe. - CR#1 did not have a Discharge MDS transmitted within the required timeframe. This failure affected 1 prior resident and could place an additional 52 current residents at risk of not having their assessments transmitted timely. Findings Include: Record review of CR #1's admission sheet revealed she was a [AGE] year old female who admitted to the facility on [DATE] and readmitted to the facility on [DATE] and discharged on 2/9/2022. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident's drug regimen was free from the administration of unnecessary drugs (in the presence of adverse consequences which indicate the dose should be reduced or discontinued/for excessive duration/without adequate indications for use/duplicate therapy), for 1 of 3 residents (Resident #8) reviewed for unnecessary psychotropic medications. Resident #8 was receiving antidepressant, Sertraline (Zoloft), for diagnosis of depression without adequate indications for continuing the same dose. The deficient practice could place the resident at risk for complications resulting from receiving unnecessary medication.