Not rated by CMS — ratings are suppressed for new or low-volume facilities.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Complete Care At Meriden during CMS and state inspections, most recent first.
A resident with mental health diagnoses and requiring ADL assistance was involved in a verbal altercation with a nurse aide, during which the aide spoke loudly, used inappropriate language, and repeated the resident's foul language back to them. Witnesses, including a dietary aide and an LPN, confirmed the aide's unprofessional conduct, which did not align with facility policies on resident rights and dignity.
A resident with cognitive impairment and a known risk for elopement exited the facility unsupervised after staff failed to properly investigate an emergency exit door alarm. Despite care plans and interventions such as a wander guard and scheduled visual checks, staff did not follow elopement protocols, resulting in delayed search and notification. The resident was later found by police at a nearby location after experiencing chest pain.
A resident with cognitive impairment and a history of wandering did not have a physician's order or care plan in place for a wanderguard, despite staff notes indicating its use and ongoing wandering behavior. Facility staff were unclear about when the device was applied, and required documentation and assessments were missing prior to the resident's elopement from the facility. The necessary care planning and monitoring interventions were only implemented after the resident was found outside the facility.
The facility experienced issues with food storage practices in the dry storage area, including an open bag of chocolate chips and detergent bottles stored alongside food items. Inconsistent documentation of daily meal temperatures was also observed, with missing entries in the logs. Improper food handling was noted, such as a cook using bare hands to handle hamburger rolls during plating. Additionally, maintenance issues with ice machines were identified, including pink debris buildup on the ice outlet and water overflow onto the floor. The buildup was attributed to improper use of ice containers with juice residue. Cleaning practices were found to be insufficient, with wet floors in the nourishment room and the need for manual emptying of ice machine catch trays. Housekeeping staff were unsure of the frequency for tray emptying.
The facility failed to obtain consent and physician's orders for bed rails for six residents, did not perform annual bed rail inspections, and did not follow its policy for bed rail use and maintenance.
The facility failed to ensure that a resident with dementia had their diagnosis reflected in their care plan and did not include a facial hematoma in another resident's care plan despite a physician's order to monitor it. Interviews confirmed that it was the responsibility of the MDS Coordinator and nurses to update care plans as needed.
The facility failed to revise the care plan for a resident with dementia and Alzheimer's disease regarding the utilization of side rails in a timely manner. Observations identified that the resident's bed had two half side rails up, contrary to the care plan. An interview with the DNS revealed that the care plan had not been revised since 2020 and lacked a physician's order.
The facility failed to provide a discharge transition plan for a resident discharged AMA. Despite the resident's severe cognitive impairment and need for assistance, the responsible party took the resident home without receiving a proper discharge plan, as confirmed by the RN and DON.
A resident with multiple diagnoses, including chronic pain syndrome, experienced a fall and later reported new hip pain. The nursing staff administered pain medication but did not reassess the resident, attributing the pain to the chronic condition. An x-ray was ordered but not obtained before the resident was transferred to the ER for an unrelated issue. Interviews revealed that the RN should have reassessed the resident, and the facility did not provide a policy for RN assessments.
A resident with multiple diagnoses and a moderate fall risk was left unattended in an unsafe position with a high bed, leading to a fall. The resident had reported a malfunctioning side rail, which was not addressed over the weekend. The facility's failure to ensure timely maintenance and appropriate supervision resulted in the resident's fall and transfer to an acute care facility.
The facility failed to communicate a resident's fall to the community center providing specialized services. The resident, who had multiple diagnoses including end-stage renal disease, fell out of bed and the incident was not documented in the communication book. This led to the specialized service center withholding heparin and transferring the resident to the Emergency Department post-treatment.
The facility failed to ensure timely review and follow-up of pharmacy recommendations for two residents. One resident had no follow-up on recommendations for alternative medications due to swallowing difficulties, and another resident had delayed action on a recommendation to evaluate and consider discontinuation of lorazepam PRN due to the lack of a stop date.
The facility failed to maintain accurate clinical records for two residents involved in an alleged physical mistreatment incident. A resident with dementia expressed pain when a nurse aide forcefully attempted to put them to bed, witnessed by another resident. The incident was not documented in the clinical records, contrary to facility policy.
The facility failed to ensure that PBJ data was complete and accurate for multiple quarters, identifying excessively low weekend staffing. The Administrator revealed that the data inputted automatically through payroll did not capture hours worked by agency or shared staff, and agency staff did not punch in. This issue had been fixed for 2024.
The facility's QAA committee meetings lacked the required attendance of the Medical Director and Infection Preventionist for three consecutive months. The Administrator and DNS confirmed that the Medical Director attends quarterly medical staff meetings instead, and the Infection Control Nurse does not attend QAPI meetings due to her part-time schedule.
Failure to Treat Resident with Respect and Dignity During Verbal Exchange
Penalty
Summary
A deficiency occurred when a resident with a history of depressive episodes, anxiety, delusional disorders, and auditory hallucinations was not treated with respect and dignity during an interaction with a nurse aide (NA). The resident, who required assistance with activities of daily living (ADLs) and had a BIMS score of 13/15, became upset during an incident involving spilled food. Witnesses reported that the NA spoke to the resident in a loud and harsh manner, questioning the resident's ability to clean themselves and using inappropriate language. The resident responded with foul language, and the NA repeated the phrase back to the resident, further escalating the situation. Multiple staff members, including a dietary aide and an LPN, overheard the exchange and confirmed that the NA's tone and volume were inappropriate. Facility documentation and interviews indicated that the NA's conduct did not align with the facility's policies on resident rights and professional behavior. The NA engaged in a verbal exchange with the resident, raising her voice and repeating the resident's foul language, rather than de-escalating the situation or maintaining professionalism. The incident was reported to supervisory staff, who acknowledged that the NA's actions were unprofessional and did not uphold the resident's right to be treated with respect and dignity.
Failure to Prevent Elopement Due to Inadequate Supervision and Alarm Response
Penalty
Summary
A deficiency occurred when a resident with moderate cognitive impairment, a history of wandering, and a documented risk for elopement was able to exit the facility unsupervised. The resident had diagnoses including metabolic encephalopathy, alcohol-induced dementia, and anxiety, and required supervision for activities of daily living. The care plan and risk assessments identified the resident as being at moderate risk for elopement, with interventions such as a wander guard bracelet and visual checks every 1-2 hours. Despite these measures, the resident was able to leave the building without staff knowledge. On the day of the incident, the resident was last seen in the hallway, and shortly after, the emergency exit door alarm sounded. A nurse aide responded to the alarm, reset it, but did not investigate the cause or check outside to see if anyone had exited. The nurse aide was unaware that the alarm required further investigation, despite having received prior education on the policy. The resident was not located during subsequent checks, and staff did not immediately follow the facility's elopement protocol, such as initiating a facility-wide search or alerting the appropriate personnel in a timely manner. The resident was eventually found by police at a nearby facility, having complained of chest pain and requiring emergency department evaluation. Interviews with staff revealed gaps in knowledge and execution of elopement protocols, including failure to investigate door alarms and delays in notifying supervisors and initiating search procedures. The emergency exit door in question was not equipped with a wander guard alert system, and staff responses did not align with facility policy for elopement prevention and management.
Failure to Implement and Document Wanderguard Use for Resident with Wandering Behavior
Penalty
Summary
The facility failed to ensure that a resident with a known history of wandering had appropriate physician's orders and a care plan in place for a wanderguard, as required by facility policy. The resident was admitted with diagnoses including metabolic encephalopathy, alcohol-induced dementia, and anxiety, and was identified as having moderately impaired cognition and requiring assistance with activities of daily living. Despite multiple nursing and psychiatric notes documenting the resident's wandering behavior and the use of a wanderguard, there was no evidence in the medical record of an elopement assessment, progress note, or care plan addressing the use of the wanderguard prior to the resident's elopement event. Staff interviews revealed uncertainty regarding when the wanderguard was initially placed on the resident and a lack of documentation for the required physician's order, elopement assessment, and care plan updates. The facility's own policies directed that residents at risk for elopement should have care plans indicating such risk, with detailed monitoring interventions, and that the use of a wanderguard should be supported by physician orders and documented checks for functionality. However, these steps were not completed prior to the resident's elopement. The deficiency was further highlighted when the resident was found missing from their room and later located wandering outside the facility, requiring police and hospital involvement. Only after this incident was a physician's order for the wanderguard documented, and the care plan updated to reflect the resident's elopement risk and necessary interventions. Prior to the event, the lack of proper assessment, documentation, and care planning failed to address the resident's known wandering behavior and elopement risk.
Food Storage and Handling Deficiencies Noted in Dry Storage and Ice Machine Maintenance
Penalty
Summary
The facility failed to ensure proper food storage practices in the dry storage area, as observed during the survey. This included finding an open bag of chocolate chips, detergent bottles, and scrub pads stored alongside food items. Additionally, there was a lack of consistent documentation of daily food meal temperatures, with missing entries noted in the temperature logs. The report also highlighted instances of improper food handling, such as a cook using bare hands to handle hamburger rolls during plating, contrary to recommended food safety practices. Furthermore, observations revealed issues with the maintenance of ice machines, with pink debris buildup noted on the ice outlet and water overflow from the machines onto the floor. The maintenance director attributed the buildup to improper use of ice containers with juice residue. The report also pointed out deficiencies in cleaning practices, as evidenced by wet floors in the nourishment room and the need for manual emptying of ice machine catch trays to prevent overflow. Housekeeping procedures were found to be lacking, with staff unsure of the frequency of tray emptying.
Failure to Obtain Consent and Physician's Orders for Bed Rails
Penalty
Summary
The facility failed to acquire consent and physician's orders prior to the initiation of bed rails for six residents. For Resident #27, the facility did not obtain the necessary consents and physician's orders upon admission, only doing so after surveyor inquiry. Similarly, Resident #28 had bed rails in place without prior consent or physician's orders, which were only obtained after the surveyor's inquiry. Resident #34 also had bed rails without the required documentation, and the bed rail inspection was outdated, with the last inspection being over a year old before a new inspection was conducted after surveyor inquiry. Resident #87 had bed rails in place without documented consent or physician's orders, and the bed rail inspection was not updated annually as required. The Director of Maintenance admitted to not having completed the inspection since the previous year. Resident #212 had bed rails in place without any indication for use or consent obtained, and Resident #215 had bed rails without consent, with the last inspection being outdated by over a year. The facility's policy required annual inspections and obtaining consent and physician's orders, which were not followed. Interviews with the Director of Nursing Services (DNS), Director of Operations, and the Medical Director revealed that they were unaware of the lapses in obtaining consents and physician's orders for bed rails. The facility's policy directed that upon admission, each resident would be assessed for the need for bed rails, consent/education would be obtained prior to installation, and maintenance staff would complete an annual review of the condition and conduct any necessary maintenance. These steps were not followed, leading to the deficiencies identified by the surveyors.
Failure to Reflect Dementia Diagnosis and Facial Hematoma in Care Plans
Penalty
Summary
The facility failed to ensure that a resident with a diagnosis of dementia was properly reflected in the resident's care plan. Resident #28, who had diagnoses of dementia and Alzheimer's disease, exhibited behaviors such as yelling and striking out at staff and was resistant to care. The care plan dated 3/11/2024 did not mention dementia or Alzheimer's disease, despite the Minimum Data Set (MDS) assessment identifying cognitive loss. Interviews with RN #4 and RN #3 confirmed that the care plan did not reflect the dementia diagnosis and that it was the responsibility of the MDS Coordinator and nurses to update care plans as needed. A care plan addressing dementia was only added after the deficiency was identified during the survey on 4/2/2024. Additionally, the facility failed to develop a care plan for a facial hematoma present on admission for Resident #212. The resident, who had diagnoses including heart failure and diabetes mellitus, was admitted with a facial hematoma and a physician's order to monitor the area every shift. However, the care plan dated 3/22/2024 did not include the hematoma, despite the presence of a physician's order and the identification of the hematoma in the electronic record. Interviews with the ADNS and RN #4 confirmed that the care plan should have included the hematoma, and it was the responsibility of the MDS Coordinator and nurses to update care plans as needed. The facility did not provide a policy for baseline care plans when requested.
Failure to Revise Care Plan for Side Rail Utilization
Penalty
Summary
The facility failed to revise the care plan for a resident with dementia and Alzheimer's disease regarding the utilization of side rails in a timely manner. The resident's care plan, dated 3/11/2024, indicated that the bed should be kept in a low position and the side rails tied down to prevent the resident from putting their arms through the rails. However, observations on 4/3/2024 and 4/4/2024 identified that the resident's bed had two half side rails up. An interview and record review with the Director of Nursing Services (DNS) on 4/4/2024 revealed that the care plan intervention for side rails had not been revised since 2020 and did not include an indication for use or a physician's order.
Failure to Provide Discharge Transition Plan for AMA Discharge
Penalty
Summary
The facility failed to ensure a discharge transition plan was provided to the responsible party for a resident who was discharged Against Medical Advice (AMA). Resident #104, who had diagnoses including cerebral vascular disease and mild cognitive impairment, was identified as severely cognitively impaired and required moderate assistance with toileting. On the day of discharge, the responsible party decided to take the resident home, and the family signed the resident out AMA. Although medication and instructions were provided, a discharge transition plan was not discussed or provided to the family, as confirmed by the Registered Nurse (RN) on duty and the Director of Nursing (DON). The facility's policy for AMA discharges requires that a discharge transition plan be provided to the resident or their representative, including community referrals and documentation of the discharge process. However, in this case, the RN on duty did not recall discussing the discharge plan or living arrangements with the responsible party, nor did he provide a discharge transition plan. This failure to follow the facility's policy resulted in a deficiency in the discharge process for Resident #104.
Failure to Reassess Resident After Fall
Penalty
Summary
The facility failed to ensure that a resident reporting new pain following a recent fall was properly assessed. Resident #87, who had diagnoses including end-stage renal disease, hypertension, chronic pain syndrome, anxiety, and morbid obesity, experienced a fall on 3/18/24. Despite being identified as at moderate risk for falls and having a care plan in place, the resident was not reassessed for pain after the fall. Initially, no injuries or pain were noted, but later, during an occupational therapy session, the resident reported increased right hip pain. The nursing staff administered pain medication, but the resident was not reassessed by the RN on duty, who attributed the pain to the resident's chronic condition. An x-ray was ordered but could not be obtained before the resident was transferred to the Emergency Department for an unrelated issue. Interviews with the nursing staff and the Director of Nursing Services revealed that the RN on duty should have reassessed the resident following the report of new pain. The Advanced Practice Registered Nurse also confirmed that the new pain was different from the resident's chronic pain and warranted further assessment. The facility did not provide a policy for RN assessments when requested, highlighting a gap in their procedures for handling such incidents. This failure to reassess the resident's new pain following a fall constitutes a deficiency in the care provided by the facility.
Failure to Prevent Accident Hazard Leading to Resident Fall
Penalty
Summary
The facility failed to prevent an accident hazard for a resident who sustained a fall after being left in an unsafe position with the bed in a high position. Resident #87, who had diagnoses including end-stage renal disease, hypertension, chronic pain syndrome, anxiety, and morbid obesity, was identified as being at moderate risk for falls. Despite this, the resident was left unattended on their left side with the bed in a high position, leading to a fall. The resident had previously reported a malfunctioning side rail, which was not addressed over the weekend, contributing to the incident. On the day of the fall, a nurse aide (NA #2) left Resident #87 in an unsafe position to report a skin integrity issue and the broken side rail to the nurse. During this time, the resident rolled out of bed and fell. The Director of Maintenance was not notified of the broken rail over the weekend, and the rail was only fixed on the morning of the fall. Interviews with staff revealed that the bed rail was in a fixed down position and the bed was in a high position at the time of the fall. The Director of Nursing (DNS) and other staff members acknowledged that the resident should not have been left in an unsafe position and that proper notifications regarding the malfunctioning equipment were not made. The facility's failure to ensure timely maintenance and appropriate supervision resulted in the resident's fall and subsequent transfer to an acute care facility. The incident highlighted lapses in communication and adherence to safety protocols within the facility.
Failure to Communicate Resident Fall to Specialty Service Center
Penalty
Summary
The facility failed to ensure that a recent fall experienced by a resident was communicated to the community center providing specialized services. Resident #87, who had diagnoses including end-stage renal disease, hypertension, chronic pain syndrome, anxiety, and morbid obesity, fell out of bed on 3/18/24 after being positioned on their left side by a nurse aide. The fall was noted in the nurse's notes, but there was no documented communication to the Specialty Service Center regarding the incident. This lack of communication led to the resident reporting the fall and a head strike to the specialized service center, which subsequently withheld heparin and transferred the resident to the Emergency Department post-treatment. Interviews with the Licensed Practical Nurse and the Director of Nursing Services revealed that the nursing staff did not document the fall in the communication book that accompanies the resident to the community center. The facility's policy for Specialized Treatment Communication Form directs staff to ensure the completion of the communication form to coordinate care between the center and the facility. The failure to document and communicate the fall represents a deficiency in the facility's adherence to its own policies and procedures, potentially compromising the resident's care and safety.
Failure to Ensure Timely Review and Follow-Up of Pharmacy Recommendations
Penalty
Summary
The facility failed to ensure timely review and follow-up of pharmacy recommendations for two residents. For Resident #27, who had diagnoses including COPD, dementia, and bipolar disorder, a pharmacy note dated 6/26/23 recommended alternative medications for divalproex and pantoprazole due to swallowing difficulties and clarifying administration directions for potassium chloride. However, there was no physician response or follow-up on these recommendations. The DNS confirmed the absence of follow-up for the Drug Regimen Review dated 6/26/23 and could not provide a reason for the missing follow-up. For Resident #28, who had diagnoses including dementia, Alzheimer's disease, and delusional disorders, a pharmacy consultant document dated 11/28/23 recommended evaluating and considering discontinuation of lorazepam PRN due to the lack of a stop date, as per CMS guidelines. This recommendation was not addressed timely, resulting in a second recommendation on 1/30/24. The DNS could not explain why the initial recommendation was not addressed, leading to a delay in action. The facility's policy indicated that pharmacy recommendations should be acted upon within 10 working days, which was not adhered to in these cases.
Failure to Document Alleged Physical Mistreatment Incident
Penalty
Summary
The facility failed to maintain a complete and accurate clinical record for two residents involved in an alleged physical mistreatment incident. Resident #156, who had dementia and muscle weakness, was identified as severely cognitively impaired and required assistance with activities of daily living. Resident #159, who had an aneurysm of the artery of the lower extremity, was moderately cognitively impaired and required assistance with bed mobility and transfers. On the evening of 11/2/22, Resident #159 allegedly witnessed a nurse aide, NA #3, forcefully attempting to put Resident #156 to bed against their will, causing Resident #156 to express pain. This incident was reported, and NA #3 was removed from the building pending investigation. However, there was no documentation of this incident in the clinical records of either resident. An interview with RN #2, who was the nursing supervisor on duty during the incident, confirmed that she was notified of an altercation and observed Resident #159 kicking NA #3, who was holding Resident #159's wrists to prevent further assault. RN #2 intervened and learned that Resident #159 had concerns about the care provided to Resident #156. A skin check was conducted for Resident #156, and the Director of Nursing Services (DNS) was notified. Both RN #2 and the DNS acknowledged that the incident should have been documented in the clinical records of both residents, as per the facility's policy for charting and documentation.
Incomplete and Inaccurate PBJ Data Submission
Penalty
Summary
The facility failed to ensure that Payroll Based Journal (PBJ) data was complete and accurate for Quarter 4 of 2023, Quarter 3 of 2023, Quarter 2 of 2023, and Quarter 1 of 2023. The PBJ submissions for these quarters identified excessively low weekend staffing. An interview with the Administrator revealed that the data for the PBJ is inputted automatically through payroll, and the facility did not capture the hours worked by agency or shared staff. Additionally, the Administrator indicated that agency staff do not punch in, and this issue had been fixed for 2024. A review of the facility policy for Nursing Services and Sufficient Staff identified that the facility is responsible for submitting timely and accurate staffing data through the CMS Payroll-Based Journal system.
Failure to Include Required Members in QAA Committee
Penalty
Summary
The facility failed to have a Quality Assessment and Assurance (QAA) committee consisting of the minimum required members. The QAPI meeting sign-in sheets for three consecutive months identified the attendance of the Administrator, Director of Nursing Services (DNS), and other staff members, but the Medical Director and Infection Preventionist were not in attendance. During an interview, the Administrator and DNS confirmed that the Medical Director does not attend the monthly QAPI meetings but attends the quarterly medical staff meetings, which are different from the QAPI meetings. Additionally, the Infection Control Nurse, who is a corporate nurse and works at the facility three days a week, does not attend the QAPI or medical staff meetings as they occur on Fridays, a day she does not work.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Meriden
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Connecticut Baptist Homes, Inc | 1.3 mi | — | 0 | 0 |
| Apple Rehab Coccomo | 1.8 mi | — | 0 | 0 |
| Silver Springs Care Center | 1.9 mi | — | 4 | 0 |
| Curtis Home St Elizabeth Center, The | 2 mi | — | 0 | 0 |
| Meriden Health And Rehab | 2.2 mi | — | 4 | 0 |
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