Medilodge of Grand Blanc

Inspectors wroteBased on observation, staff interviews, and record review, the facility failed to ensure that clean linens were consistently available to meet residents' needs. This resulted in delayed incontinence care and bathing for one resident (Resident #103) of four residents reviewed for quality of care.

Inspectors wroteThis Citation pertains to intake Number 2997144. Based on observation, interview, and record review, the facility failed to ensure that residents were treated with respect and dignity during the provision of care for one resident (Resident #102) of five residents reviewed for dignity with care.

Inspectors wroteThis Citation pertains to intake Number 3011645. Based on interview and record review, the facility failed to ensure that comprehensive, resident centered care plans were implemented as written for one resident (Resident #105) out of five residents reviewed for care plan implementation.

Inspectors wroteBased on interview and record review, the facility failed to implement care plan interventions for one resident (Resident #3) of three residents reviewed for falls, resulting in a fall with fracture.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain best practices in the food service area, resulting in the potential to spread food borne illness to all residents who consume food from the kitchen.

Inspectors wroteBased on observation, interview and record review, 1) The facility failed to implement and operationalize a comprehensive infection control program, encompassing outcome surveillance, accurate data documentation/analysis resulting in potential infection and the spread of microorganisms and illness to all 126 facility residents, and 2) the facility failed to have an active plan for reducing the risk of legionella and other opportunistic pathogens of premise plumbing (OPPP). This deficient practice has the increased potential to result in waterborne pathogens to exist and spread in the facility's plumbing system and an increased risk of respiratory infection among all residents in the facility.

Inspectors wroteBased on interview and record review, the facility failed to implement and operationalize a comprehensive antibiotic stewardship program including analysis and ongoing evaluation of appropriate antibiotic use resulting in the potential development of antibiotic-resistant organisms and inappropriate antibiotic use for all 126 facility residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents were treated in a dignified manner, call lights were within reach, and needs were met timely for five residents (#4, #42, #45, #53, #122) and a confidential group of residents.

Inspectors wroteThis Citation Pertains to Intake Number 2627046. Based on observation, interview and record review, the facility failed to implement and operationalize procedures to ensure that Activity of Daily Living (ADL) care was provided to six residents (#1, #2, #9, #16, #82, and #123) of eleven residents reviewed, resulting in a lack of daily and hygiene care for dependent residents.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain nebulizer equipment (a medical device that turns liquid medication into a fine mist to be inhaled directly into the lungs for treatment of respiratory conditions) in a sanitary manner for four residents (#16, $#84, #118 and #119), of seven residents reviewed for respiratory care and ventilator/tracheostomy care.

Inspectors wroteBased on interview and record review, the facility failed to ensure advance directives were completed appropriately and the care plan for advance directives was updated for one resident (R130) of six residents reviewed for advance directives, resulting in one cognitively impaired resident changing their code status and an inaccurate care plan.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that physical restraints were not used for staff convenience for one resident (Resident #118) of one resident reviewed, resulting in restriction of mobility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents' Minimum Data Set (MDS) assessments accurately reflected the residents' status for one resident (Resident #32) of one resident reviewed for MDS discrepancies.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement planned interventions for contracture management for one resident (Resident #16) of three residents reviewed resulting in lack of application of splints.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that tube feeding was administered per professional standards of practice and the plan of care for one resident (Resident #40) of two residents reviewed.

Inspectors wroteThis citation pertains to Intake Number 2607274. Based on observation, interview, and record review, the facility failed to obtain an appropriate resident assessment, physician's order, develop a care plan, and provide entrapment measurements to ensure that a resident is free from physical restraint for one resident (Resident #107) (R107) of 3 residents reviewed for use of side rails.

Inspectors wroteThis citation pertains to intake Number 2607274. Based on observation, interview, and record review, the facility failed to ensure that Enhanced Barrier Precautions (EBP) were implemented according to the plans of care for two residents (Resident #107 and Resident #104) of the three residents reviewed for Infection Prevention and Control.

Inspectors wroteThis citation pertains to Intake #1223361Based on observation, interview, and record review the facility failed to ensure that an adequate supply of clean linen was distributed and consistently delivered to residents' areas on a daily basis.

Inspectors wroteThis Citation Pertains to Intake Number MI00153753. Based on observation, interview and record review, the facility failed to ensure measures were in place to prevent constipation for two Residents (#1 and #3) of 3 reviewed for constipation, resulting in the potential for discomfort, restlessness and adverse reactions. Findings Include: Resident #1: A record review of the Face sheet and Minimum Data Set/MDS assessment indicated Resident #1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses: Diabetes, End stage renal disease, renal dialysis, Cardiac arrest, seizures, Hepatitis B, anemia, acute and chronic respiratory failure, dysphagia, feeding tube, hypertension and pneumonia. The MDS assessment dated [DATE] revealed the resident had cognitive loss and needed assistance with all care. [...]

Inspectors wroteThis Citation pertains to Intake Number MI00152171. Based on interview and record review, the facility failed to notify the resident's representative of a change in condition for one resident (Resident #2) of three residents reviewed, resulting in the family not being notified of a change in condition.

Inspectors wroteResident #705: A review of Resident #705's medical record revealed an admission into the facility on 4/8/11 and re-admission on [DATE] with diagnoses that included acute and chronic respiratory failure, dependence on respirator status, Muscular Dystrophy and tracheostomy status. A review of the Minimum Data Set assessment revealed a Brief Interview of Mental Status score of 15/15 that indicated intact cognition, the Resident had limited range of motion of bilateral upper extremities and was dependent on helper for activities of daily living, mobility and transfers. A review of the Facility Reported Incident investigation for Resident #703 of an interview written by Nurse C for Resident #705, dated 3/10/25 at 8:35 AM, that revealed: (Resident #705) asked for yankauer, she refused stating she doesn't do that you need to get respiratory to do it. I don't do respiratory job. [...]

Inspectors wroteThis citation pertains to Intake Number MI00148741 Based on observation, interview and record review the facility failed to maintain sanitary conditions in the kitchen, resulting in improper kitchen sanitization of all kitchenware utilized to prepare and plate resident meals, soiled floors and ice machine potentially affecting all residents who consume meals from the kitchen

Inspectors wroteBased on observation, interview and record review, the facility failed to act on positive influenza laboratory results timely and operationalize policies and procedures for an influenza outbreak with two Residents (#30 and 45), of two residents reviewed for positive influenza, resulting in the potential for the spread of infection to residents, staff, surveyor and visitors.

Inspectors wroteBased on interview and record review the facility failed to curate an activities program that met the interest and needs of the facility residents, resulting in, activity programming being monotonous and lacking originality. With nine residents from resident council expressing feelings of frustrations, discontentment, and unimportance.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain a clean/sanitary, safe, and homelike environment with soiled privacy curtains in rooms 207, 505, 507, 509; Call lights not within reach for Resident #3, #35, #105 and room [ROOM NUMBER]-1; Respiratory equipment not stored properly for Resident #102, #57 and #407 soiled wheelchairs, geri chairs and walker stored in the common/dining area on the 300 hall; ceiling tile coming down in the bathroom between rooms [ROOM NUMBERS]; multiple bathrooms on the 300 hall with personal wash basins stored improperly and not labeled with resident information; denture cups in room [ROOM NUMBER] not properly labeled with resident information; [...]

Inspectors wroteThis Citation Pertains to Intake MI00148741 Based on observation, interview and record review, the facility failed to ensure dignified and respectful care and treatment for two (# 4 and 61) of two residents and five of five residents observed during the dining task resulting in lack of supervision during meals as care planned for one resident (R39) and availability of equipment during dining, Resident #4 being exposed during care, and Resident #61 expressing delayed staff response to needs, unnecessary incontinence, discourteous and rude staff, lack of adaptive communication devices, and Resident verbalization of feelings of fear, anxiety, and frustration.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive activity care plan for one (#61) of one resident reviewed resulting in the potential for lack of meaningful activities and decreased quality of life.

Inspectors wroteThis Citation Pertains to Intake MI00148741 Based on observation, interview and record review, the facility failed to ensure the provision of the necessary services to ensure timely response and assistance for completion of Activity of Daily Living (ADL) care for three (#'s 39, 43, and 61) of seven residents reviewed resulting dependent residents not receiving timely care including repositioning, toileting, and hygiene and resident verbalization of discomfort and feelings of frustration and embarrassment.

Inspectors wroteBased on interview and record review, the facility failed to treat a change in condition timely for one resident (Resident #30) of one resident reviewed for delay in treatment, resulting in the potential for exacerbation of signs and symptoms of pneumonia, sepsis, extended illness and wellbeing.

Inspectors wroteBased on observation, interview and record review, the facility failed to enact care-planned interventions for safety/monitoring/supervision for Residents (#4, 35 and 39) of 9 reviewed for accident hazards and feeding assistance, resulting in the potential for injury for Resident #4 transferred with a mechanical lift with one staff assist, fall with injury for Resident #35 who did not have a call light within reach and a fall mat placed at the bedside, and the potential for choking or aspiration of food for Resident #39.

Inspectors wroteBased on observation, interview and record review the facility failed to provide catheter care in accordance with current clinical standards for one (#50) resident of 1 resident reviewed for catheters, resulting in, Resident #50 returning from the emergency room with a urinary catheter unbeknownst to the facility and without proper assessment, monitoring and ongoing care. Findings Include: Resident #50: During initial tour on 1/8/2025, Resident #50 was observed in bed conversing with his wife. Observed hanging on the bed frame was a catheter drainage bag that was partially full of urine. Resident #50 explained he recently was evaluated at the Emergency Room, and they placed a catheter. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure enteral tube feeding (liquid nourishment provided directly into the stomach through a feeding tube) administration was per Health Care Provider orders and professional standards of practice for one resident (#55) of three Residents reviewed, resulting insufficient head of bed elevation during tube feeding administration and the potential for aspiration, infection, and decline in overall health.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement and operationalize policies and procedures for management and care of a Peripherally Inserted Central Catheter (catheter line inserted into the arm and extends to the heart for long term administration of intravenous [IV] medications- PICC) line for one (#280) of one Resident reviewed resulting in a PICC line not being flushed following medication administration and the potential for malfunction, occlusion, blood clot formation, and infection.

Inspectors wroteBased on interview and record review, the facility failed to acquire medication timely from pharmacy services or obtain from back-up medication storage for one resident (Resident #45), of seven reesidents reviewed for medication regimen review, resulting in medication Bumetanide and Spironolactone not administered as ordered and the potential of exacerbation of medical conditions.

Inspectors wroteBased on interview and record review, the facility failed to administer medication as ordered by the practitioner for one resident (Resident #45) of seven residents reviewed for medication administration, resulting in Resident #45 not receiving the medication Bumetanide (a diuretic often used to reduce extra fluid in the body caused by conditions such as heart failure, liver disease, and kidney disease) and the medication Spironolactone (a diuretic often used to treat heart failure and high blood pressure), the residents need to have increased dosage of the medication Bumetanide and the potential for exacerbation of medical conditions.

Inspectors wroteThis citation pertains to Intake #MI00148741. Based on observation, interview and record review the facility failed to promptly dispose of 24 pills of oxycodone (opioid used to manage pain) and maintain accurate and legible controlled medication reconciliation records for one (#61) resident of eight resident residents reviewed for narcotic reconciliation. Findings Include: On 1/14/2025 at 1:50 PM, Vent Medication Cart 3 in the presence of Wound Care Nurse R and Nurse S. While reviewing Resident #61's Controlled Substance Log for Oxycodone IR (immediate release) 5 MG (milligram) Tab (tablet) received on 5/19/2024. The sheet was found to have rows of crossed out entries, with what appeared to be multiple witnessed initials, but they were difficult to match up to the specific row given the disorganization of the narcotic form. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure immunizations were reviewed and offered for/to Resident #45, of six residents reviewed for immunizations, resulting in the potential for lack of protection against infectious diseases and illnesses and spread of infection.

Inspectors wroteThis Citation pertains to Intake Number MI00143979. Based on observation, interview and record review, the facility failed to prevent staff-to-resident abuse for one resident (Resident #604) of 3 residents reviewed for abuse, resulting in a staff member using verbally abusive language towards Resident #604. Findings Include: Resident #604: A record review of the Face sheet and Minimum Data Set/MDS assessment indicated Resident #604 was admitted to the facility on [DATE] with diagnoses: Paranoid schizophrenia, hypothyroidism, heart failure, anxiety, depression and intellectual disabilities. The MDS assessment dated [DATE] indicated the resident had moderate cognitive decline with a Brief Interview for Mental Status score of 8/15. The resident also needed assistance with all care. [...]

Inspectors wroteThis Citation will have two Deficient Practice Statements (DPS). DPS #1: This Citation pertains to Intake Number MI00147169. Based on interview and record review the facility failed to assess, monitor and implement substantial interventions to prevent Resident #608's overdose, resulting in Resident #608 admitting with a Polysubstance abuse disorder of 40 + years without further facility follow-up, assessment or increased monitoring,and a fentanyl patch being applied in a reachable area resulting in subsequent ingestion of the patch, which resulted in an overdose. Findings Include: Resident #608: [...]

Inspectors wroteThis Citation pertains to Intake Number MI00146559. Based on observation, interview, and record review, the facility failed to ensure proper Personal Protection Equipment (PPE) gowning for treating one resident (Resident #605), resulting in the likelihood of contamination during Percutaneous Endoscopic Gastrostomy (PEG) tube site care and the spread of infection.

Inspectors wroteThis Citation pertains to Intake Number MI00146121. Based on observation, interview, and record review, the facility failed to ensure that pain assessment was completed consistently and medication was administered as ordered over an extended period for one resident (Resident #901) of two residents (with acute displaced fracture of right ankle) reviewed for pain management. This deficient practice has the potential for reduced efficacy of the pain management regimen with prolonged pain.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure proper label and dating of foods with 69 residents consuming meals from the kitchen (34 residents receive nothing by mouth) resulting in increased risk of contaminated foods and the risk of food borne illness.

Inspectors wroteBased on interview and record review the facility failed to maintain complete and accurate medical records for one Residents (#81) of 21 residents reviewed for accurate medical records resulting in missing, incomplete, and inaccurate information intentionally put in all 103 residents' medical charts routinely every Wednesday morning, pertinent to care needs with the potential for negative outcomes and the inability to accurately assess, monitor and update progress related to resident centered plans of care for this vulnerable population.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure required transfer and discharge documentation was completed for one (#81) of two residents reviewed for discharge. Resulting in the potential for ineffective or mismanaged continued care, as care plan goals were omitted from the transfer paperwork.

Inspectors wroteBased on interview and record review, the facility failed to meet transfer/discharge documentation requirements for one of one reviewed (Resident #81) from a total of 21 sampled residents, resulting in the potential for residents and/or their representatives not obtaining their due rights.

Inspectors wroteBased on observation, interview and record review the facility failed to complete and provide a baseline a care plan within 48 hours of admission 1 resident (resident # 401) of 4 reviewed for care plans, resulting in anxiety, frustration and the potential for unmet needs to be addressed in their plan of care.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure care plans were updated and revised appropriately with new interventions for one (R81) out of 21 residents reviewed for care plan revision out of a total sample of 21 residents. This deficient practice resulted in lack of revision and implementation for a bowel regimen following a hospital stay for surgical removal of a bowel impaction.

Inspectors wroteBased on observation, interview and record review the facility failed to provide Activity of Daily Living (ADL), including bathing/showering and nail care, for one resident (R#75) of three reviewed for ADL care completion resulting in missed bathing/showers, inadequate nail care and potential for feelings of embarrassment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate care, management, and documentation for one (R60) of one resident reviewed for bowel and constipation, of a total sample of 21, resulting in lack of appropriate monitoring and treatment, increasing the potential for another bowel impaction causing surgical removal and decline in overall health status.

Inspectors wroteBased on interview and record review the facility failed to ensure for 1 out of 5 residents (Resident #90) the Physician was made aware of, and addressed medication monitoring requirements, resulting in the potential for adverse affects to occur. Findings Included: Per the facility face sheet Resident #90 (R90) was admitted on [DATE]. R90 had a listed diagnosis of, DEPENDENCE ON RENAL DIALYSIS. Review of Physician's orders (ordered by R90's primary physician) revealed that on 12/27/2023 at 11:35 AM, Vancomycin was ordered for R90 as follows, . (Vancomycin HCl [hydrochloride]) Use 1 gram intravenously one time a day every Mon, Wed, Fri, Sun for antibiotic until 01/05/2024 23:59 (11:59 PM) to be given on dialysis day by dialysis nurse, in dialysis. The order revealed the Vancomycin was discontinued on 12/28/2023. [...]

Inspectors wroteBased on interview and record review, the facility failed to offer pneumococcal vaccines as recommended by Centers for Disease Control, in three of five residents reviewed for immunizations (Resident #2, #33 and #68) resulting in increased risk of acquiring, transmitting, or experiencing complications from pneumococcal disease.

Inspectors wroteBased on interview and record review, the facility failed to provide notification of the bed hold policy upon transfer to the hospital for one (R81) of one reviewed for transfer to the hospital, from a total sample of 21 residents, resulting in the inability at the time of transfer to make his decision regarding reserving a bed during a period of absence from the facility.