Health inspection·September 14, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based 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. Findings include: An observation of Resident #44 on 9/12/2023 at 9:39 a.m., the resident was sitting in his specialized wheelchair, groomed, and sitting in front of the nursing desk. The resident is not interview able. Record review of documentation provided by the facility revealed a PASRR/IDT meeting was held on 2/23/2023 with recommendations to order a custom wheelchair for Resident #44. Interview on 9/12/2023 at 2:09 a.m. with the Administrator, she said that there were changes with Resident #44 during this time(after the IDT meeting in February 2023 was held), there were plans in place dealing with guardianship and discharge to another location that led to the issue with PASRR/IDT and the receipt of his wheelchair. The facility was told that by the wheelchair manufacturor that the wheelchair would not be ready prior to his discharge and that the wheelchair would be ordered after his discharge so that the delivery would go to his new home, so the order was held and the staff that was previously dealing with the wheelchair was no longer an employee but the email correspondence regarding the ordered wheelchair was being emailed to her old email and they were not aware. Interview on 9/14/2023 at 9:00 a.m. with the MDS Coordinator, he said that he did not assume the position of MDS Coordinator until 4/18/2023 and that the MDS Coordinator is responsible for PASRR/IDT and making sure that the resident receives services as requested. He said that he did not know that Resident #44 had orders to receive a new wheelchair because the staff that was previously dealing with the wheelchair was no longer an employee but the email correspondence regarding the ordered (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 7 Event ID: 676260 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676260 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meridian 2228 Seawall Blvd Galveston, TX 77550 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)