Inspection Report Summary
The most recent inspection on October 7, 2024, identified deficiencies related to supervision of assisted living aides and client safety during transfers, as well as failures to coordinate services and update service plans. Earlier inspections showed a mixed pattern, with some renewal inspections finding no violations and several complaint investigations citing issues such as inadequate supervision, failure to update care plans, delayed emergency responses, and staffing concerns. Complaint investigations included substantiated findings of insufficient supervision resulting in client injury and inadequate management of client behaviors and safety. Enforcement actions such as fines or license suspensions were not listed in the available reports. The inspection history shows ongoing challenges with client safety and service coordination, with no clear trend of consistent improvement or worsening over time.
Deficiencies (last 7 years)
Deficiencies (over 7 years)
1.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
70% better than Connecticut average
Connecticut average: 5.6 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
82% occupied
Based on a August 2024 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Oct 7, 2024
Visit Reason
An unannounced visit was made to Bal Meriden on October 7, 2024, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a complaint investigation survey.
Complaint Details
Complaint #40747 triggered the investigation. The complaint involved failure to supervise assisted living aides and ensure client safety, resulting in injury to Client #3. The Executive Director indicated that Client #1 passed away on 9/1/24.
Findings
The investigation found that the Supervisor of Assisted Living Services failed to provide supervision of assigned assisted living aides and failed to ensure the safety of Client #3 during a transfer, resulting in injury and difficulty breathing. The agency and supervisor failed to identify supervision of aides and ensure client safety.
Deficiencies (1)
Supervisor of Assisted Living Services failed to provide supervision of assigned assisted living aides and ensure safety of Client #3 during a transfer, resulting in injury and difficulty breathing.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elizabeth Heiney | Supervising Nurse Consultant | Author of the letter and contact for plan of correction submission. |
| Jody Dona | Executive Director | Interviewed regarding the incident and notified of findings. |
Inspection Report
Plan of Correction
Deficiencies: 1
Date: Oct 7, 2024
Visit Reason
An unannounced visit was made to Bal Meriden on October 7, 2024, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation.
Complaint Details
The visit was complaint-related under Complaint CT #41193. The complaint involved incidents of client altercations and failure to properly assess and manage client behaviors and safety.
Findings
The investigation identified violations of Connecticut State Regulations related to the failure of the Assisted Living Services Agency (ALSA) to ensure client safety, coordinate services, and update service plans according to agency policies and state regulations. Specific findings included inadequate assessment and intervention for client behaviors, failure to ensure client safety during altercations, and failure to update medication and service plans.
Deficiencies (1)
Failure to ensure client safety, coordinate services, and update service plans in accordance with agency policies and state regulations.
Report Facts
Complaint number: 41193
Plan of correction submission deadline: Oct 31, 2024
Client admission dates: Client #1 admitted 10/31/21, Client #2 admitted 11/30/21, Client #4 admitted 2/28/23
Service plan dates: Client service plans dated various dates including 2/12/24, 6/11/24, 6/5/24, 9/27/24
Medication dosage: 25
Medication dosage: 12.5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elizabeth T. Heiney | Supervising Nurse Consultant | Author of the plan of correction letter and contact for response |
Inspection Report
Renewal
Census: 110
Capacity: 134
Deficiencies: 0
Date: Aug 2, 2024
Visit Reason
The inspection was a licensing renewal inspection conducted to review compliance with state regulations and verify facility operations.
Findings
No violations of the General Statutes of Connecticut or regulations were identified at the time of this inspection. The re-licensure survey included a tour and review of various facility documents such as meeting minutes, personnel folders, staffing schedules, and clinical record reviews.
Report Facts
Memory care capacity: 24
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jody Abel Dona | Executive Director | Personnel contacted during inspection |
| Erica Tucker | Personnel contacted during inspection | |
| Michael J. Smith | Nurse Consultant | Inspection report submitted by |
Inspection Report
Complaint Investigation
Deficiencies: 0
Date: Oct 30, 2023
Visit Reason
The inspection visit was conducted as a complaint investigation related to Complaint Investigation #35259 and to identify any violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies.
Complaint Details
Complaint Investigation #35259 was the basis for the visit; violations were found and documented in an attached violation letter.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection, as noted in an attached violation letter dated 11/8/23.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jody Abel Dona | Executive Director | Personnel contacted during the inspection |
| Kebra Smith-Bolden | SALSA | Personnel contacted during the inspection |
Inspection Report
Plan of Correction
Deficiencies: 1
Date: Oct 30, 2023
Visit Reason
An unannounced visit was made to Bal Meriden on October 30, 2023 by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting an investigation.
Complaint Details
Complaint #35259 triggered the investigation.
Findings
The Assisted Living Services Agency (ALSA) failed to follow the agency's Significant Changes in a Client's Status and Elopement Risk Assessment and Interventions policy, specifically failing to identify and update the client's elopement risk assessment and service plan based on changes in condition to ensure client safety.
Deficiencies (1)
Failure to follow the agency's Significant Changes in a Client's Status and Elopement Risk Assessment and Interventions policy, including failure to identify the client's elopement risk and update the service plan accordingly.
Report Facts
Complaint number: 35259
Effective date: Dec 1, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Elizabeth Heiney | Supervising Nurse Consultant | Named as contact for response and instructions related to the plan of correction |
Inspection Report
Renewal
Census: 84
Deficiencies: 0
Date: Aug 18, 2022
Visit Reason
The inspection was conducted as a licensing inspection for renewal purposes, including verification of Alzheimer's special care units and compliance with infection prevention and control requirements.
Findings
The report indicates that the facility was reviewed for licensing renewal and compliance with applicable regulations, including a review of the plan of correction dated 9/17/21. No violations or citations were issued at the time of this inspection.
Report Facts
Census: 84
Alzheimer's special care units: 68
Memory care residents: 16
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael J. Smith | RN Nurse Consultant | Report submitted by |
| Jody Abel Dona | Ex. Director | Personnel contacted during inspection |
| Roland Garcia | RN, SALSA | Personnel contacted during inspection |
Inspection Report
Renewal
Census: 84
Capacity: 134
Deficiencies: 0
Date: Aug 18, 2022
Visit Reason
The inspection was conducted as a licensing renewal inspection for the ALSA facility, BAL Meriden/Village Kensington Place.
Findings
No violations of the General Statutes of Connecticut or regulations were identified at the time of this inspection. The previously reviewed Plan of Correction dated 9/17/21 was also reviewed during this inspection.
Report Facts
Census: 84
Total Capacity: 134
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Michael J. Smith | Nurse Consultant | Report submitted by and signature on inspection report |
| Jody Abel Dona | Ex. Director | Personnel contacted during inspection |
| Roland Garcia | RN, SALSA | Personnel contacted during inspection |
Inspection Report
Renewal
Capacity: 134
Deficiencies: 0
Date: Sep 27, 2021
Visit Reason
The inspection was conducted as a licensing renewal inspection for the facility.
Findings
No violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of this inspection.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Tammy Kuczynski | SALSA Designee | Personnel contacted during the inspection. |
| David Pimini | Service Coordinator | Personnel contacted during the inspection and managed residential community visited. |
Inspection Report
Complaint Investigation
Census: 60
Deficiencies: 1
Date: Sep 17, 2021
Visit Reason
An unannounced visit was made to Bal Meriden on September 17, 2021, by a representative of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting a complaint survey.
Complaint Details
Complaint #30737 triggered the investigation. The Executive Director failed to adequately investigate delays in service call response and failed to ensure adequate staffing to meet client needs.
Findings
The agency failed to respond timely to clients' emergency pendant alarms and failed to ensure adequate staffing to meet clients' needs. Multiple instances of delayed response times to emergency calls were documented, and staffing was found inadequate on several dates in August 2021.
Deficiencies (1)
Failure to respond timely to clients' emergency pendant alarms and failure to ensure adequate staffing to meet clients' needs.
Report Facts
Census: 60
Staffing ratio: 3
Response times: Multiple response times to emergency pendant alarms ranged from 12 minutes to over 40 minutes, exceeding the agency's policy of responding within seven minutes.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Cheryl Davis | Public Health Services Manager | Signed letter regarding the complaint survey and instructions. |
| Tiffany Kuczynski | RN SALSA | Recipient of the inspection report and plan of correction. |
Inspection Report
Plan of Correction
Deficiencies: 5
Date: Jan 16, 2020
Visit Reason
Unannounced visits were made to BAL Meriden on November 21, 2018, December 18, 2019, and January 16, 2020 by representatives of the Facility Licensing and Investigations Section of the Department of Public Health for the purpose of conducting multiple investigations.
Findings
Multiple violations of Connecticut State Agencies regulations and General Statutes were identified, including failure of the governing authority to develop policies conforming to state regulations, inadequate staffing response times, failure to provide appropriate dementia training, and failure to properly review and document client care plans and assessments.
Deficiencies (5)
The governing authority failed to develop policies to conform to State regulations, including failure to notify the ALSA registered nurse or EMS after a client fall and unsafe handling of the client.
Executive Director failed to investigate delays in service call response and SALSA failed to ensure adequate staffing to meet client needs.
ALSA failed to ensure provision of appropriate dementia training for an aide assigned to care for clients with dementia.
SALSA/registered nurse failed to review aide documentation of care for clients requiring ALSA aide services.
SALSA/registered nurse failed to ensure client service plan and instructions included need for wheelchair for a client requiring one.
Report Facts
Dates of visits: November 21, 2018, December 18, 2019, January 16, 2020
Call pendant response times: 25
Dementia training hours missing: 8
Dates of hire and admission: Employee hire date 3/16/16; Client admissions 5/23/14, 12/10/19, 1/8/13, 5/25/18
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Loan Nguyen | Supervising Nurse Consultant | Signed the notice letter regarding violations |
| Mary Lou Fahy | Senior Regional Director of Resident Care | Addressee of the notice letter |
| LPN #10 | Named in findings related to client fall and failure to notify ALSA RN or EMS | |
| Executive Director | Named in findings related to failure to investigate delays in service call response | |
| ALSA Aide #4 | Named in findings related to failure to provide dementia training | |
| RN #1 | Named in findings related to failure to review aide documentation |
Inspection Report
Renewal
Census: 103
Deficiencies: 0
Date: Nov 21, 2018
Visit Reason
The inspection was conducted as a renewal licensing inspection and included a complaint investigation (Complaint Investigation #20673).
Complaint Details
Complaint Investigation #20673 was referenced in the inspection report, but no substantiation status was explicitly stated.
Findings
Violations of the General Statutes of Connecticut and/or regulations of Connecticut State Agencies were identified at the time of the inspection. Approval for issuance of license was granted.
Report Facts
Number of ALSA clients: 103
Number of home visits: 2
Number of records reviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Denise Jones Coleman | Supervisor | Personnel contacted during inspection |
| William Allen | Executive Director | Personnel contacted during inspection |
| Noben Barrios | Report submitted by | |
| Loan Q Nguyen | Supervisor | Approval for issuance of license granted by |
Inspection Report
Complaint Investigation
Census: 82
Deficiencies: 3
Date: Feb 21, 2017
Visit Reason
The inspection was conducted as a complaint investigation (#20693) and licensing inspection at The Village at Kensington Place, an assisted living services agency.
Complaint Details
Complaint investigation #20693 was conducted based on allegations related to client service program participation, personnel file documentation, and hospice service coordination. The complaint was substantiated with identified violations.
Findings
The inspection identified violations related to failure to ensure participation of clients or families in the development of client service programs, failure to maintain required personnel files documentation, and failure to coordinate hospice services. Deficiencies were documented with corrective measures and timelines.
Deficiencies (3)
Failure to ensure participation of clients or families in the development of client service programs for multiple clients.
Failure to identify documentation of 2016 annual physical examinations and tuberculin testing for ALSA aides #2, #3, #4, and #5 personnel files.
Failure to coordinate hospice services with the hospice agency for a client receiving hospice care.
Report Facts
Census: 82
Number of home visits: 2
Number of records reviewed: 5
Date measures will be effective: 2017
Employees mentioned
| Name | Title | Context |
|---|---|---|
| William Allyn | Executive Director | Signed plan of correction letter |
| Christine Sampson | Supervisor of Assisted Living Services Agency | Named as personnel contacted and supervisor in findings |
Inspection Report
Complaint Investigation
Census: 32
Deficiencies: 0
Date: Feb 14, 2017
Visit Reason
The inspection was conducted as a renewal licensing inspection and included a complaint investigation (Complaint Investigation #20693).
Complaint Details
Complaint Investigation #20693 was conducted; substantiation status is not explicitly stated.
Findings
Violations of the General Statutes of Connecticut and/or regulations were identified at the time of this inspection. The report references attached violation letters but does not detail specific deficiencies in the pages provided.
Report Facts
Census: 32
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Christine Sampson | Resident Care Director | Personnel contacted during inspection and author of email regarding license expiration |
| Rose McLellan | License & Applications Supervisor | Author of letter responding to license expiration inquiry |
| Loan Nguyen | Supervising Nurse Consultant | Contact person mentioned for questions regarding license renewal |
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