Covenant Skilled Nursing and Rehabilitation at Wel

Inspectors wroteBased on observation, interview and record review, the facility failed to 1) Maintain food preparation and kitchen equipment in a sanitary and good working condition, and 2) Ensure that all partly used or opened foods had a use-by date, resulting in an increased likelihood for food borne illness with hospitalization, and cross contamination affecting a census of 32 residents who consumed oral nutrition from the facility kitchen. Findings Include: Review of the Public Health Service 2009 Food Code, adopted by the Michigan Food Law, effective October 1, 2012, Chapter 4-501.14 directs that equipment cleaning frequency is to be throughout the day at frequency necessary to prevent recontamination of equipment and utensils. 4-602.11 Equipment Food-Contact Surfaces and Utensils. (A) EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be cleaned: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a clean and safe environment for 5 of 8 residents' room observations (resident rooms: #22, #26, #32, #34, and #40), and for 4 of 6 residents from the confidential resident group meeting which took place on 03/24/36, resulting in verbalization of frustration and anger regarding condition of resident rooms, and an increased risk for cross contamination, risking resident health and welfare. Findings Include: This citation pertains to Intake Number 2806043. Review of the facility Maintaining a Clean Environment policy, dated March 2021, stated Cleaning a resident's room both daily cleanings and upon discharge includes the following: [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure daily snacks were offered and delivered per 6 of 6 resident complaints during a confidential resident group meeting, resulting in resident verbalizations of anger and frustration with complaints, and the failure to offer and deliver snacks to residents documented to receive evening snacks. Findings Include:Review of the facility snack policy dated February 2014, stated the snacks were to be given to resident's Between-meal (and) are offered to resident's (daily), except when contraindicated; document snack consumption. During the confidential resident group meeting held on 3/24/26 at 11:10 a.m., 6 of 6 attendees verbalized anger and frustration regarding not knowing they could even have snacks, not being offered daily snacks, and not receiving any snacks.

Inspectors wroteBased on observation, interview and records review, the facility failed to ensure that 1 resident (R #35) had ADL care done daily, and that 1 resident (R#55) had a privacy bag covering the urinary catheter bag, of 22 Residents reviewed for dignity.

Inspectors wroteBased on interview and record review, the facility failed to ensure that two residents (#3 and #8) of 22 residents reviewed, were fully informed, per consent, of the dosage and frequency of the psychotropic and/or antidepressant medications they were receiving.

Inspectors wroteBased on Interview and record review, the facility failed to ensure a safe discharge for 1 resident (Resident #53) of 3 closed records reviewed, resulting in the potential for ineffective or mismanaged continued care, an Adult Protective Services referral or safe placement and a facility discharge summary review.

Inspectors wroteThis citation pertains to Intake Number 2806043. Based on observation, interview and record review, the facility failed to ensure that 3 residents' care plans (#16, #55 and #56) of 22 residents' care plans reviewed were up to date with resident specific interventions, resulting in the high risk for improper or non-specific nursing interventions with poor continuity of care. Findings Include: Resident #16: Review of the Face Sheet, Diagnosis Sheet, nursing notes dated 3/26, and care plans dated 2/25/26 and 3/10/26, revealed Resident #16 was 88 years-old, alert and able to make own healthcare decisions, required staff assistance with all Activities of Daily Living (ADL's), and was non-weight bearing. The residents diagnosis revealed, sepsis, fall with fracture of right fibula (leg bone), fracture of right ankle, and facility acquired pressure ulcer (PU) on right foot. [...]

Inspectors wroteBased on observation, interview and records review the facility failed to prevent facility-acquired skin injuries for 1 resident (Resident #56) of 22 residents reviewed, resulting in the development of bilateral heel redness with the verbalization for pain and discomfort and likelihood of prolonged illness.

Inspectors wroteBased on interview and record review, the facility failed to ensure that a venue that was convenient to both parties was clearly identified in the arbitration agreements for 2 residents (Resident #14 and Resident #43) of 2 residents reviewed, resulting in the likelihood for unresolved arbitration disputes.

Inspectors wroteThis citation pertains to Intake Number 2806043. Based on observations, interview and record, the facility failed to ensure proper handwashing was done during dining and medication pass observations, ensure that1 resident's (Resident #16) of 1 resident reviewed for CPAP, mask was properly stored when not in use, and ensure that 1 resident (Resident #55) of 2 residents reviewed for urinary catheter use, catheter bag was off the floor, resulting in an increased risk for cross contamination and respiratory infection, and an increased risk for contamination during meals and medication administration from lack of handwashing, with risk of resident illnesses and hospitalization. Findings Include: Resident #16: [...]

Inspectors wroteThis Citation pertains to Intake Number MI00151167. Based on interview and record review, the facility failed to provide showers as scheduled for two residents (#701 and #703) of four residents reviewed for Activities of Daily Living (ADL), resulting in complaints of showers not being provided consistently.

Inspectors wroteBased on interview and record review the facility failed to effectively monitor four (#6, 91, 137 & 138) residents of 7 residents reviewed for unnecessary medications, resulting in improper indications for usage and duplicate therapy without rationale. Findings Include: Resident #6: On 2/14/2025 at 10:05 AM, a review was conducted of Resident #6's clinical record and it indicated she admitted to the facility on [DATE] with diagnosis that included, Pneumonia, Heart Disease, Depression and Anxiety. Further review yielded the following: Physician Orders: Buspirone HCl Oral Tablet 10 MG- given 1 tablet by mouth two times a day related to anxiety disorder. Ordered on 1/22/2025. Duloxetine HCI oral capsule delayed release sprinkle 60 MG- give 1 capsule by mouth one time a day related to anxiety disorder. Ordered on 1/25/2025. According to the U.S. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to 1) Maintain food preparation and kitchen equipment in a sanitary and good working condition, and 2) Ensure all open and partly used foods were dated, resulting in an increased likelihood for food borne illness with hospitalization, and cross contamination affecting 34 residents who consumed oral nutrition from the facility kitchen of a total census of 34 residents. Findings Include: Review of the Public Health Service 2009 Food Code, adopted by the Michigan Food Law, effective October 1, 2012, Chapter 4-501.14 directs that equipment cleaning frequency is to be throughout the day at frequency necessary to prevent recontamination of equipment. On 2/12/25 at 10:00 a.m., during the initial tour of the main kitchen accompanied by small kitchen Dietary Manager B. [...]

Inspectors wroteBased observation, interview and record review, the facility failed to 1) Ensure 1 resident (Resident #93) had the ordered Cervical collar (C-collar) on while up in wheelchair, 2) Ensure 1 resident (Resident #138) had accurate admission documentation, and 3) Ensure 1 resident's (Resident #137) wound care was done per physician's orders, resulting in the potential for increased cervical damage, decreased wound healing, and incomplete admission assessment. Findings Include: Resident #93: Review of the Face Sheet, physician orders, progress notes and nursing notes dated 1/28/25 through 2/13/25, care plans dated 2/12/25 and Kardex (dated 2/13/25), revealed Resident #93 was 75 years-old, alert with confusion and communication deficit, admitted for rehab on 1/28/25, and was dependent of staff for assist with Activities of Daily Living (ADL). [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 2 of 4 medication carts were clean and sanitized for a census of 34 residents who receive medications, resulting in the potential for cross contamination. Findings Include: [NAME] Hall Medication Cart: During observation done on 2/12/25 at 11:27 a.m. on [NAME] Hall, the fourth medication drawer down was noted to have an excessive amount of dried on liquid medications on the bottom of the drawer. The Pro-State bottle had dried on drips on the sides and it had leaked onto the bottom of the drawer; no staff member had cleaned it up. Also, crushed meds-like substances and small pieces of paper were found in the corners of the fourth drawer along with the Milk of Magnesia bottle that had dried on medication drippings on the sides. [...]

Inspectors wroteThis Citation pertains to Intake Number MI00144619. Based on observation, interview and record review the facility failed to prevent the development and/or worsening of pressure injuries and complete accurate documentation and timely implementation of wound care treatments for two residents (Resident #201 and Resident #205) of two residents reviewed for wounds, resulting in Resident #201's Stage II pressure ulcers worsening, untimely initiation of treatment orders and inconsistent wound assessment documentation and the development of an avoidable Stage II pressure sore behind Resident #205's ear. Findings Include: Resident #201: [...]

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 27 residents.

Inspectors wroteBased on observation and interview the facility failed to provide a safe, functional, and sanitary environment for the facility's census of 27 residents and its staff resulting in an increased potential for harm.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that accurate advance directive information was in place for one resident [Resident #8 (R8)] of one resident reviewed for advance directives (legal documents that allow a person to identify decisions about end-of-life care ahead of time), resulting in the potential for a resident's preferences for medical care to not be followed by the facility, or other healthcare providers. Findings Include: Review of the MICHIGAN DO-NOT-RESUSCITATE PROCEDURE ACT, Act 193 of 1996 (Revised 3-25-14), revealed, An order executed under this section shall be on a form described in section 4. The order shall be dated and executed voluntarily and signed by each of the following persons: [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure proper storage of medications for one resident (Resident #171), and 1 of 3 medication carts reviewed, resulting in the increased likelihood for residents, visitors, and/or staff to access the medications.