Medilodge of Cass City

Inspectors wroteBased on observation, interview, and record review, the facility failed to have an active and ongoing plan for reducing the risk of legionella and other opportunistic pathogens of the premise's plumbing.

Inspectors wroteBased on interview and record review the facility failed to develop a comprehensive care plan for one resident (R31) of 16 residents reviewed for comprehensive care plans, resulting in the absence of a diabetic management care plan and the potential for unmet care needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure appropriate measures were in place, assessed for effectiveness and the resident was monitored to prevent constipation for one resident (Resident #56) of 1 resident reviewed for constipation, resulting in Resident #56 experiencing discomfort, restlessness and adverse reactions after not having a bowel movement for 8 days.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a comprehensive bowel elimination care plan, ensure documented assessments and changes for a colostomy (an opening in the abdomen through which stool from the colon can be discharged into a bag) for one resident (Resident #38) of one resident reviewed for colostomy (ostomy), resulting in a lack of overall documentation of the colostomy care with the likelihood of signs and symptoms of complications going unnoticed.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that dialysis communication forms were completed and included pre-dialysis and post-dialysis assessments and accurate identification of the dialysis access site for one resident (Resident #5) of 1 resident reviewed for dialysis services, resulting in the potential for a decline in condition and the inability for a prompt response to care needs.

Inspectors wroteBased on interview and record review, the facility failed follow physician-ordered medication administration parameters for two residents (R31, R49) of five residents reviewed for unnecessary medications, resulting in medications being administered outside of parameters.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement and operationalize processes and procedures to ensure pharmacological oversight of controlled and narcotic medications, including accurate electronic order entry, monitoring and accountability of receipt, dispensing, administration, and disposal in two of three medication carts and one of medication rooms reviewed. This deficiency resulted in expired medications as well as inaccurate controlled and narcotic medication reconciliation for five residents (Resident #3, Resident #11, Resident #31, Resident #50, and Resident #503) and the likelihood for additional medication errors, inappropriate medication use and administration, and diversion which has the potential to affect all 68 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement and operationalize policies and procedures for labeling, storage, and disposition of medications and medical supplies in three (A, B, and C Hall) of four medication carts, one of one medication room, and one closet containing medications and medical supplies resulting in open and undated medications, medications and medical supplies being stored in an unlocked closet, and the likelihood for unauthorized access to medications and medical supplies, and Residents to receive expired medications with altered potency and efficacy.

Inspectors wroteBased on interview and record review, the facility failed to ensure dignified and respectful treatment for one resident (Resident #28) of two residents reviewed, resulting in staff speaking to Resident #28 in an undignified and belittling manner and the resident's verbalization of feelings of frustration and discontentment.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the provision of hygiene and daily care for two residents (Resident #28, and Resident #48) of four residents reviewed, resulting in unkept and long toenails, foul odors, and exposed, visible stool on the bedside commode in Resident #48's room.

Inspectors wroteBased on observation, interview and record review the facility failed to prevent the development of three (one Stage IV and two unstageable) pressure ulcers for one resident (Resident #31), resulting in, Resident #31 developing a right ankle unstageable wound, a left ankle unstageable wound and a Stage IV coccyx wound and delayed wound healing.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement and operationalize policies and procedures to ensure a thorough investigation, accurate documentation, and implementation of meaningful interventions for fall prevention for two residents (Resident #16 and Resident #23) of two residents reviewed for falls, resulting in a lack of accurate Minimum Data Set (MDS) documentation, comprehensive analysis of falls, a lack of updated and meaningful interventions to prevent falls, and the likelihood of unnecessary pain and injury.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure positioning and follow care-planned interventions during enteral feeding for two residents (Resident #19, Resident #50) of two residents reviewed for enteral feeding assistance, resulting in the likelihood of aspiration and/or enteral tube malfunction.

Inspectors wroteBased on observation, interview and record review, the facility failed to store and care plan Continuous Positive Airway Pressure (CPAP) masks appropriately, administer oxygen per physicians' orders and provide appropriate water for the CPAP machine for three residents (Resident #22, Resident #23, Resident #67) of three residents reviewed for Oxygen/CPAP use, resulting in the likelihood of infection and abnormal oxygen levels.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the medication error rate was less than 5% when three medication errors were observed from a total of 25 opportunities for three residents (Resident #56, Resident #501, and Resident #503) of five residents reviewed. This deficient practice resulted in a medication error rate of 12% and the potential for the risk of adverse medication effects and decreased medication efficacy.

Inspectors wroteBased on observation and record review, the facility failed to perform hand hygiene and ensure proper Personal Protection Equipment (PPE) (gown, gloves) for one resident (Resident #19), resulting in the likelihood of contamination during wound care and incontinence care and the spread of infection.

Inspectors wroteThis Citation pertains to Intake Numbers MI00134661 and MI00142794. Based on observation, interview and record review, the facility failed to provide a functional call light in a timely manner for two residents (Resident #9, Resident #30), resulting in delayed staff response to the residents' needs and feelings of frustration and worry.

Inspectors wroteBased on observation, interview and record review the facility failed to implement infection control practices related to COVID-19 (COVID) for four residents (#2, #3, #4, #5) of 5 residents sampled resulting in missing Transmission Based Precaution (TBP) orders for residents positive with COVID, missing COVID positive care plans, missing trash cans for contaminated personal protective equipment (PPE), lack of PPE outside of the rooms and the potential for spreading COVID in the facility.

Inspectors wroteThis Citation Pertains to Intake Number MI00142937. Based on observation, interview and record review, the facility failed to justify the use of a PRN/as needed antianxiety medication and document rationale for prolonged PRN use for one resident (#1), resulting in the potential for unnecessary medications and adverse effects. Findings Include: A review of the Face sheet and Minimum Data Set (MDS) assessment for Resident #1 revealed an admission into the facility on [DATE] with diagnoses: Schizophrenia, heart failure, hypertension, Systemic Lupus (an autoimmune disorder), anxiety, depression, pathological dislocation of left hip (present on admission), and hypothyroidism. The MDS assessment dated [DATE] indicated the resident had a Brief Interview for Mental Status (BIMS) score of 11/15 revealing moderate cognitive loss. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to implement and operationalize policies and procedures to ensure safe and sanitary food storage, sanitary conditions in the kitchen, and ensure kitchen equipment was maintained and inspected, resulting in the potential for equipment malfunction, injury, and foodborne illness for all residents who consume food from the kitchen.

Inspectors wroteBased on interview and record review the facility failed to curate an Activities Program that met the interest of facility residents and consistent weekend programming for residents, resulting in an activities program being monotonous, lacking originality, weekend programming since April 2023 not consistently being conducted and residents expressing feelings of frustrations, discontentment, and unimportance.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement and operationalize a comprehensive Infection Control (IC) program including outcome and process surveillance, data analysis and reporting for all infections, and environmental cleaning/sanitization processes/procedures for all 48 facility residents. This deficient practice resulted in of lack of surveillance for potential infections and infections not requiring antimicrobial therapy, incomplete and inaccurate infection analysis, lack of thorough tracking and surveillance of employee illness, lack of comprehensive environmental surveillance, drain fly infestation, and the likelihood for the development and transmission of communicable diseases and infections for all residents. Findings Include: [...]

Inspectors wroteBased on observation, interview, and record review the facility provide a safe, functional, sanitary, and comfortable environment for the facility residents, resulting in (1) ineffective maintenance of residents' rooms (drywall exposed, unfinished drywalling projects, holes/gaps in walls,; (2) infestation of sewer flies, (3) facility tracking of pest/rodents, and (4) 10-month delay of B-Hall shower room repair. Findings Include: During initial tour on 9/12/2023, the following was observed in resident rooms: Room D2: Behind the resident's headboard was a large white area that appeared to be drywall that had been fixed but never painted. The area was not smooth but rough. Room D7: On the right- hand side of the wall, near the heat register were 3-4 gaps in the wall where the drywall met the baseboard. Across the top of the call light box was a 3-4-inch gap in the drywall. [...]

Inspectors wroteThis Citation has Two Deficient Practice Statements (DPS). DPS One: Based on observation, interview and record review, the facility failed to ensure urinary catheter drainage bags were maintained in a dignified manner for one resident (Resident #24) of one resident reviewed, resulting in a lack of dignity covering for an indwelling urinary catheter drainage bag.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a homelike environment for two residents (Resident #27, Resident #38), resulting in a shared television, an unkempt bathroom sink and difficulty in bed mobility with the feelings of less self-worth and frustration.

Inspectors wroteBased on observation, interview, and record review the facility failed to collaborate with hospice services for one resident (Resident #2), resulting in hospice and the facility failing to establish an effective communication and collaborative process for Resident #2, including how the communication will be documented between the facility and the hospice provider, to ensure that the needs of the resident are addressed and met 24 hours per day. Findings Include: Resident #2: On [DATE], Resident #2 was observed watching television in her room. She provided yes and no questions to this writer as she had multiple tooth extractions the day prior. On [DATE] at approximately 2:00 PM, B Hall nurse was asked how hospice communicates with the facility. It was explained each resident had a hospice book that is at the nurse's station and she was asked for Resident #2's hospice book. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure suprapubic catheter (surgically created connection between the skin to the urinary bladder used to drain urine from the bladder) care was completed, per professional standards of practice for one resident (Resident #7) of one resident reviewed resulting in lack of timely assessment/documentation, management, implementation of care, as ordered, and the likelihood for alterations in skin integrity and feelings of embarrassment utilizing the reasonable person concept related to leaking suprapubic catheter.

Inspectors wroteBased on observation, interview and record review, the facility failed to operationalize policies and procedures for a Peripherally Inserted Central Catheter (PICC line - catheter inserted in the body through the arm that extends to the heart and is utilized for long term administration of intravenous [IV] medications) care for one resident (Resident #24) of one resident reviewed, resulting in a lack of dating on a PICC line dressing, Resident verbalization of concerns related to lack of care, and the likelihood for infection and alteration in overall health status.

Inspectors wroteBased on observation, interview and record review, the facility failed to assess, monitor and provide oxygen per physician's orders for one resident (Resident #6), resulting in a low oxygen saturation, no oxygen application with the likelihood of confusion and continued decreased oxygen blood saturation and respiratory complications.

Inspectors wroteBased on interview and record review, the facility failed to administer Levothyroxine per physician's orders and alone on an empty stomach for three residents (Resident #6, Resident #26, Resident #38) resulting in increased dosages with the likelihood of malabsorption and increased signs and symptoms of Hypothyroidism.

Inspectors wroteBased on observation, interview and record review, the facility failed to administer insulin correctly for two residents (Resident #26, Resident #28), resulting in the incorrect administration with the likelihood of not receiving the entire dose of insulin.

Inspectors wroteBased on observation, interview and record review, the facility failed to store and label medications for one medication cart and the medication room, resulting in a multi-dose vial of Lidocaine left opened and undated and a medication cart being left unlocked and unattended for 7 minutes with the likelihood of cross-contamination, theft or medication misuse.