Majestic Care of Livonia

Inspectors wroteBased on observation and interview, the facility failed to ensure appropriate cross-connection prevention resulting in the potential for contamination of ice in the ice machine, affecting all residents.

Inspectors wroteThis citation pertains to Intake 2617467Based on observation, interview, and record review, the facility failed to honor a resident's right to refuse a shower and treated the resident with respect for one resident (R25) of two residents reviewed for the right to a dignified existence.

Inspectors wroteBased on interview and record review, the facility failed to timely submit an MDS (Minimum Data Set) resident assessment for one resident (R77) of one reviewed for resident assessment.

Inspectors wroteThis citation pertains to Intakes 2728688 and 2728168. Based on observation, interview, and record review, the facility failed to ensure timely care was provided to meet the needs for five residents (R2, R36, R63, R75, R98) of 19 whose care was reviewed.

Inspectors wroteBased on interview and record review, the facility failed to ensure timely completion and follow up of Medication Regimen Reviews (MRRs) for two residents (R9 and R13) of five reviewed for Medication Regimen Reviews.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide food to meet the preferences of two residents (R2, R98) of three reviewed for food palatability.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident's record accurately reflected the resident's care for one resident (R8), of one reviewed.

Inspectors wroteThis citation pertains to Intake MI00152612. Based on observation, interview, and record review, the facility failed to prevent the misappropriation of resident prescribed controlled substance (narcotic) pain medication for one (R901) of three residents reviewed for misappropriation.

Inspectors wroteThis citation pertains to Intake M100149283. Based on observation, interview, and record review, the facility failed to complete care plan revisions for one (R702) of three residents reviewed for care plans.

Inspectors wroteThis citation pertains to Intake MI00148803. Based on interview and record review the facility failed to ensure the services of a Registered Nurse (RN) were provided for at least eight consecutive hours per day on the weekend days resulting in the potential for inadequate coordination of emergent or routine care that could cause negative outcomes affecting all 90 residents in the facility.

Inspectors wroteThis citation pertains to Intake MI00148803. On 12/08/24 between 8:40 AM-9:15 AM, during an initial tour of the kitchen, the following items were observed: In the walk-in cooler, there was a pan of soup dated 11/26-12/3, an opened undated bag of breaded chicken, an undated bag of whole ham, an undated bag of sliced ham, an opened undated package of hot dogs, an undated pan of tomato sauce, a crate of fat free half pints of milk dated 12/7. In the Traulsen reach-in cooler, there was an opened undated 1 gallon container of Italian dressing, a 1 gallon container of sweet and sour sauce dated 9/13/24-10/13/24, a 1 gallon opened, undated container of BBQ sauce. On 12/8/24 at 12:05 PM, when queried about the opened, undated items, Dietary Manager I provided no explanation. According to the 2017 FDA Food Code section 3-501.17: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure one resident (R86) of one resident reviewed, was referred to with dignity regarding potentially deogatory language. Findings Include: A review of the record for R86 revealed an order entered by Licensed Practical Nurse (LPN) B dated 03/07/24 which documented, Assist feeder for all meals. The record further documented R86 was admitted into the facility 02/27/24. A review of the Minimum Data Set (MDS) assessment dated [DATE] documented, severely impaired cognition and substantial/maximal assistance for Activities of Daily Living. On 12/09/24 at 1:20 PM, LPN B was queried about the order and reported the order using the word feeder was not appropriate and should have read 'assist with all meals' or 'one to one assist with all meals'. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure a care plan was updated to reflect fall interventions for one sampled resident (R10) of three reviewed for accidents.

Inspectors wroteThis citation has two deficient practice statements. Deficient Practice Statement #1: Based on observation, interview, and record review, the facility failed to provide showers for one (R8) of four residents reviewed for hygiene.

Inspectors wroteThis citation has two deficient practices. Deficient Practice Statement #1: Based on observation, interview, and record review, the facility failed to ensure lower extremity lymphedema wraps (elestic bandage wrap applied to reduce swelling) were applied for one (R72) of four residents reviewed for care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to apply hand splints for one resident (R38) out of five residents reviewed for mobility and range of motion.

Inspectors wroteThis citation has two deficient practice statements. Deficient practice #1. Based on observation, interview, and record review, the facility failed to provide tube feeding (TF-feeding supplied through a tube into the stomach) and hydration for one resident (R346) out of three residents reviewed for tube feeding.

Inspectors wroteThis citation pertains to Intake MI00148624. Based on interview and record review, the facility failed to provide interventions for a resident with PTSD (Post-Traumatic Stress Disorder) to address triggers for one Resident (R44) of one resident reviewed for trauma-informed care.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure biologicals were dated when opened in three of three medications carts reviewed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food was served in a palatable (tasty), presentable manner for three Residents (R39, R45, and R246) of four residents reviewed for nutrition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure non-allergenic food was provided for one Resident (R13) of one reviewed for food preferences.

Inspectors wroteThis citation has two deficient practice statments. Deficient practice #1. Based on observation, interview, and record review, the facility failed to implement transmission based precautions (TBP) for one resident (R346) out of one reviewed for infection control practices.

Inspectors wroteThis citation pertains to Intake MI00147513. Based on observation, interview, and record review, the facility failed to ensure a resident with a known pressure wound was repositioned timely for one resident (R704) of six reviewed for skin care management.

Inspectors wroteThis citation pertains to Intake MI00147416. Based on observation, interview, and record review, the facility failed to provide timely brief change, peri-care and bedding change for one (R705) of four residents reviewed for care concerns.

Inspectors wroteThis citation pertains to Intake: MI00146915. Based on interview and record review, the facility failed to follow hospital discharge instructions and orders for one sampled resident (R701) of one resident reviewed for continuum of care.

Inspectors wroteThis citation pertains to Intake: MI00146528 Based on interview and record review, the facility failed to permit a resident to return to the facility after hospitalization for one resident (R901) of one reviewed for discharges.

Inspectors wroteThis citation pertains to intake MI00145985. Based on interview and record review, the facility failed to prevent the elopement of one resident (R700) of three reviewed for accidents and supervision.

Inspectors wroteThis citation pertains to Intake MI00145744. Based on interview and record review, the facility failed to implement timely treatments for a newly identified wound for one resident (R701) out of three reviewed for wounds, resulting in the worsening of the wound.

Inspectors wroteThis citation pertains to Intake: MI00145599 Based on interview and record review, the facility failed to ensure the rights to self- determination were honored for Leave of Absences (LOAs) potentially affecting all 95 residents residing in the facility.

Inspectors wroteThis citation in part pertains to Intake: MI00145599 Based on interview and record review that facility failed to assist the Resident Council to meet for their monthly meetings consistently.

Inspectors wroteThis citation in part pertains to Intake: MI00145599 Based on interview and record review the facility failed to ensure the activities program was directed by a qualified professional potentially affecting all 95 residents in the facility.

Inspectors wroteThis citation pertains to Intake M100143712. Based on observation, interview and record review, the facility failed to provide monitoring, supervision and door alarm response to prevent the elopement of one (R901) of six residents reviewed for elopement, who was a known elopement risk and wore a Wanderguard (ankle bracelet used to set off an alarm restricting a resident from walking out the door). R901 eloped from the facility on 03/25/24 at 9:10 PM unbeknownst to staff until 5:15 AM on 03/26/24. R901 was located in the community approximately 12 miles away from the facility at 1:30 AM on 03/29/24. R901 was able to exit the facility, triggering the alarm system wearing a Wanderguard without staff being aware for appoximately eight hours. [...]

Inspectors wroteThis citation pertains to Intake MI00141614. Based on observation, interview, and record review, the facility failed to report an allegation of misappropriation of funds to the State Agency for one resident (R701) out of one reviewed for misappropriation of funds. Findings Include: On 2/22/2024 at 9:54 AM, an interview was conducted with R701. R701 was observed sitting in their wheelchair. R701 stated that back in December (2023) they were asleep, woke up and saw someone standing on the side of their bed. R701 stated that they thought they were just checking on them and went back to sleep. R701 stated that the next day they went to order some food and went in their wallet and $70 was missing. R701 stated that they reported it to the Nursing Home Administrator (NHA) and they were told that they would not be getting reimbursed. [...]

Inspectors wroteThis citation pertains to Intake MI00140504. Based on interview and record review, the facility failed to follow physician recommendations following a Gastrointestinal (GI) consult, and follow physician ordered parameters upon administration of a laxative for one resident (R901) of one reviewed for unnecessary medications, resulting in the potential for adverse drug consequences.

Inspectors wroteThis citation pertains to Intake MI00140358. Based on interview and record review, the facility failed to provide wound care treatments as ordered for one resident (R802) of three reviewed for care and treatment, resulting in the potential for worsening of existing pressure ulcers and/or development of new wounds. Findings Include: A review of the Intake revealed, The complainant states the resident wasn't getting proper wound care and [R802] was sent to hospital in [date] due to the condition of [their] wounds. On 10/31/2023 at 11:55 AM, a phone interview was conducted with the complainant. The complainant stated that R802 was not receiving proper care while in facility. They stated that R802 had several pressure sores and were not receiving care. [...]

Inspectors wroteThis citation pertains to Intakes: MI00136917, MI00134758, MI00140155 and MI00137068. Based on interview, and record review, the facility failed to ensure the safety and wellbeing for five residents (R1, R8, R10, R25 and R93) out of four reviewed for abuse, to prevent physical abuse from a resident who had unpredictable behaviors and a staff member, resulting in physical abuse, bodily injuries, and psychosocial distress.

Inspectors wroteThis citation pertains to Intake MI00139096. Based on observation, interview and record review the facility failed to ensure rooms were maintained free of lingering debris and odors and trash for five residents (R3, R39, R41, R55, and R77) and eight resident rooms (Rooms 5, 7, 9, 10, 11, and 17) from a total sample of 56 residents, resulting in resident dissatisfaction with their living conditions.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain the kitchen in a sanitary manner. This deficient practice had the potential to affect all residents that consume food from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain the exterior trash refuse area in a sanitary manner. This deficient practice had the potential to affect all residents, staff and visitors.

Inspectors wroteThis citation pertains to Intakes MI00139498, MI00139958, and MI00139521. Based on observation, interview, and record review the facility failed to provide activities of daily living care (ADLs) to six residents (R4, R41, R46, R55, R91, and R96) of nine residents reviewed for ADL care, resulting in feelings of humiliation and dissatisfaction with care.

Inspectors wroteThis citation pertains to Intake M100138667. Based on interview and record review, the facility failed to allow or document reason for one (R303) of three residents reviewed for discharges to return to the facility following hospitalization, resulting in R303 not being allowed to return to the facility, be provided an appropriate discharge or coordinate mental health and/or behavioral services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to revise a fall prevention care plan after multiple falls, for one resident (R64) of six reviewed for accidents, resulting in multiple falls with major injures.

Inspectors wroteBased on interview and record review, the facility failed to implement a 14-day stop date or document rationale for continuation of a PRN (as needed) psychotropic medication for one (R88) of three residents reviewed, resulting in unnecessary psychotropic medication use with the potential for adverse side effects.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure expired biologicals were discarded and opened bilogicals were dated and labeled with a resident identifier in three of four medication carts resulting in the potential for the decreased effectiveness of biologicals and medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain tube feeding poles and a tracheostomy (trach) cart surface in a sanitary manner, for two residents (R32 and R73), resulting in the potential for contamination of equipment.