Applewood Nursing Center, Inc

Inspectors wroteThis citation pertains to Intake 3034845. Based on observation, interview, and record review, the facility failed to provide a homelike environment by not ensuring an adequate supply of clean washcloths and towels were available for nine residents (R2, R4, R14, R15, R24, R30, R77, R91, and R57) reviewed for care, resulting in resident feelings of frustration and unmet care needs. This deficient practice has the potential to affect all 138 residents who resided in the facility during the time of survey.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident (R88) at high-nutritional risk (tube feeding/multiple wounds) was appropriately assessed and failed to implement interventions resulting in unidentified severe weight loss (10.6% in one month) for one out of three residents reviewed for high nutritional risk. The Immediate Jeopardy (IJ) started on 3/17/25 when R88, a resident at high nutritional risk due to a tube feeding and multiple wounds, was admitted into the facility, and the facility neglected to ensure R88 was appropriately assessed by a qualified nutritional professional and provided adequate nutrition to prevent a severe weight loss of 10.6% in one month. The Nursing Home Administrator (NHA) and Director of Nursing (DON) were notified of Immediate Jeopardy on 4/16/25 at 2:42 PM. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Consistently document that the dish machine, reach-in coolers, and reach-in freezers were operating properly; 2. Ensure the proper sanitizing solution was obtained for the three-compartment sink; 3. Ensure pans were allowed to air dry before stacking; 4. Properly date-label prepared food stored in the reach-in cooler; and 5. Consistently maintain the kitchen in a sanitary condition. These deficient practices had the potential to affect all residents who consumed food from the kitchen, resulting in the increased potential for food borne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly dispose of rubbish and maintain cleanliness of the outside garbage area, resulting in a visually unappealing property and the potential for harborage of pests.

Inspectors wroteBased on observation, interview and record review the facility failed to adequately store medications in three of three medications storage areas.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide appropriate grooming in the form of hair care for one resident (R128) of one resident reviewed for dignity, resulting in feelings of shame, embarrassment, and anger.

Inspectors wroteBased on interview and record review the facility failed to report a significant weight loss to the physician and guardian for one resident (R1) out of three residents reviewed for a notification of a change in condition, resulting in the potential for missed opportunities to make medical decisions for the resident.

Inspectors wroteBased on observation, interview, and record review the facility failed to properly secure protected health information for two residents (R66 and R131) out of two residents reviewed for privacy of medical information, resulting in the potential for unauthorized disclosure, access, and modification.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide one resident (R128) with hair grooming out of seven residents reviewed for hair care resulting in uncombed, soiled, matted hair (hair tangled into a thick mass) with areas of tight coils of hair attached to the scalp and resident feelings of frustration and embarrassment.

Inspectors wroteThis citation pertains to Intake MI00149373. Based on observation, interview, and record review, the facility failed to ensure an adequate supply of emergency food was available.

Inspectors wroteThis citation pertains to intake MI00148149. Based on observation, interview, and record review, the facility failed to provide a clean and sanitary environment for two residents (R102 and R109), out of five residents reviewed for a clean environment, resulting in an unclean and unsanitary environment with a build-up of dried tube feeding formula on tube feeding poles and floor.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement interventions to address a chronic leaking indwelling urinary catheter (foley) for one resident (R412) of three residents reviewed for catheter care resulting in the worsening and infection of a sacral Stage 4 pressure ulcer (Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur).

Inspectors wroteBased on observation, interview, and record review the facility failed to provide comprehensive foley catheter care for one resident (R412) of three residents reviewed for catheter care resulting in a chronic leaking foley catheter and resident concerns with reopening a sacral wound.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain catheter bag privacy for one (R411) of three residents reviewed for catheter care.

Inspectors wroteBased on interview and record review the facility failed to develop, implement, and revise care plans for one resident (R404) of four residents reviewed with a tube feeding, resulting in multiple hospital admissions for peg tube reinsertion.

Inspectors wroteThis citation pertains to MI00144652, MI00145045, and MI00145057 Based on interview and record review the facility failed to implement interventions to prevent the dislodgement and manipulation of a percutaneous enteral gastrostomy tube in a timely manner (PEG) for one (R404) of four residents reviewed for quality of care, resulting in ten (10) hospital transfers/admissions for treatment and care of a peg tube/J-tube.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain sanitary conditions in the kitchen resulting in an increased potential for cross contamination of food and foodborne illness, potentially affecting the facility's total census of 129 residents who receive meal services (7 nothing by mouth residents, or NPO) out of the facility's total census of 136 residents.

Inspectors wroteThis citation pertains to intake MI00135948. Based on observation, interview and record review the facility failed to post the appropriate directions for isolation care for one resident (R32) of nine residents reviewed for infection control.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure dignity for four residents (R15, R87, R88, and R90) out of 64 residents reviewed for resident rights on unit 200.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure nail care and provide appropriate briefs for incontinence care for four residents (R7, R15, R25, and R128) of 10 reviewed for activities of daily living for dependent residents, resulting in unmet hygiene needs and residnets being left soiled for extended periods of time.

Inspectors wroteThis citation pertains to intake MI00142960. Based on observation, interview and record review the facility failed to ensure meals were served at a preferred and palatable temperature for four sampled residents (R15, R25, R88 and R90) from a total of 64 residents on the 200 unit, resulting in complaints of cold food and dissatisfaction with meals.

Inspectors wroteBased on observation and interview the facility failed to ensure that the garbage storage area was maintained in sanitary conditions resulting in an increased potential for the harborage and feeding of pests.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure confidentiality of resident's electronic medical records for two residents (R4 and R55) out of six residents reviewed for privacy. Findings Include: During an observation on 4/30/24 at 6:30 AM on Station Two, R55's electronic medical record was visible on short hall medication cart computer screen with no nurse in attendance, with the potential for any passerby to see R55's confidential information. Record review R55's electronic medical record revealed admittance into the facility on 1/24/24 with a diagnosis of debility. During an observation on 5/2/24 at 8:45 AM on Station Three, R4's electronic medical record was visible on short hall medication cart computer screen with no nurse in attendance, with the potential for any passerby to see R4's confidential information. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a clean and clutter free homelike environment for two residents (R27 and R88) resulting in soiled and cluttered resident rooms.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the Preadmission Screening/ Annual Resident Review (PASSAR) forms for Mental Illness/ Intellectual Disability/ Related Conditions Identification (DCH-3877) documents were reviewed, revised, and sent to the local state agency for annual evaluation for a Level II determination for two (R7 and R31) of eight residents reviewed for PASSARs, resulting in the potential for unmet psychosocial care needs.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide supervision for two unlocked medication carts out of 9 medication carts.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the foley catheter tubing (a flexible tube for draining urine from the bladder) did not drag along the floor during ambulation in a wheelchair for one (R133) of four residents reviewed for catheter/UTI (urinary tract infection).

Inspectors wroteBased on observation, interview, and record review the facility failed to consistently administer wound care treatments for one resident (R109) out of three residents reviewed for wound care. Findings Include: During an interview on 4/30/24 at 9:40 AM, R109 reported a sore on the middle of back. Record review revealed resident was admitted into the facility on [DATE] with diagnoses of Idiopathic scoliosis, lumbar region (Curve in spine) and muscle weakness. According to the Minimum Data Set (MDS) dated [DATE], R109 had intact cognition and required extensive assistance with Activities of Daily Living (ADLS). During a wound care observation on 5/2/24 at 11:02 AM, it was observed that resident had a foam dressing on both heels. The heel dressing was dated 4/27/24. [...]

Inspectors wroteThis citation pertains to intake MI00137764. Based on interview and record review the facility failed to implement a skin care plan upon admission to facility for one resident (R250) out of 37 residents reviewed for care plans. Findings Include: Record review of R250's electronic medical records revealed admission into the facility on 5/26/23 with a pertinent diagnosis of discitis (inflammation of discs) of vertebra (spine). According to the Minimum Data Set (MDS) dated [DATE], R250 had intact cognition and review of Section G of MDS revealed resident was extensive assist with bed mobility and transfers. Record review of admission Assessment dated 5/26/23, R250 had redness to bilateral buttocks documented under skin integrity. Record review of Braden Scale (assessment for potential skin breakdown) dated 5/26/23, R250 scored 13/23 resulting in moderate risk for skin breakdown. [...]

Inspectors wroteThis citation pertains to intake MI00139087. Based on interview and record review the facility failed to ensure adequate assistance during incontinence care (brief change) for one resident (R104) out of four residents reviewed for falls, resulting in a fracture of the right femur (thigh bone) and hospitalization.

Inspectors wroteBased on observation, interview, and record review the facility failed to prepare meals in a clean and sanitary environment resulting in the potential for food-borne illness. This deficient practice has the potential to affect all residents that consume food from the facility kitchens.

Inspectors wroteBased on observation and interview the facility failed to maintain the kitchen dish machine in working condition. This had the potential to affect all residents who consumed food from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to honor mealtime preferences for five out of five anonymous residents (attending resident council meeting) and one other resident (#113), resulting in expressed feelings of discontent with meal service.

Inspectors wroteBased on observation, interview, and record review the facility failed to train an employee on testing the dish machine to ensure sanitation resulting in the potential for food-borne illness. This deficient practice had the potential to affect all residents who consumed food from the kitchen.

Inspectors wroteBased on observation and interview the facility failed to serve food at appropriate temperatures, resulting in dissatisfaction with food served from the sub-kitchens. This deficient practice has the potential to affect all residents who consume food from the facility kitchens.

Inspectors wroteBased on interview and record review, the facility failed to ensure an evening snack was consistently offered to five of five residents who attended the resident group meeting and one other resident (#113), resulting in resident dissatisfaction and the potential for unmet resident nutritional needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident's personal belongings were inventoried and accounted for, affecting one resident (#12), of three residents reviewed for dignity, resulting in the potential for missing/unaccounted for items and resident dissatisfaction.

Inspectors wroteBased on interview and record review, the facility failed to develop an individualized comprehensive hemodialysis care plan for one resident (#27) out of four residents reviewed for dialysis, resulting in the potential for unmet care needs related to end stage renal disease.

Inspectors wroteThis citation pertains to Intake MI00131944. Based on interview and record review, the facility failed to obtain an x-ray in a timely manner for one resident (#291) of nine residents reviewed for accidents, resulting in an unidentified fracture.

Inspectors wroteBased on interview and record review, the facility failed to ensure that wound care treatments for pressure ulcers (damage to skin from prolonged pressure to skin) were consistently provided for one resident (#2) of seven residents reviewed for wound care, resulting in the potential for worsening of pressure ulcers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure catheter tubing and catheter privacy bags were off the floor for two residents (#78, #108) and catheter tubing was properly positioned and secured for one resident (#78), out of two residents reviewed for urinary catheters, resulting in resident discomfort, the potential for additional discomfort due to excessive tension and pulling, and the potential for the introduction of infectious microorganisms to the bladder.

Inspectors wroteBased on observation, interview, and record review the facility failed to assess the effectiveness of a breathing treatment and to maintain, change, and store oxygen tubing for two (#10, #62) of two residents reviewed for respiratory care, resulting in the potential for respiratory infections, respiratory distress, and exacerbation (worsening of a disease) of respiratory conditions.