Medilodge of Howell

Inspectors wroteThis citation pertains to Intake #2808113. Based on observation, interview and record review the facility failed to ensure they obtained and administered a physician ordered medication for one (R808) out of three residents reviewed for medication administration.

Inspectors wroteThis citation pertains to Intake 2806339 and 2808113Based on record review and interview, the facility failed to reconcile and administer prescribed medication (Amoxicillin, an antibiotic) according to professional standards for one (R803) and ensure the accuracy of the administration of the drug Hizentra (a medication admitted under the skin to treat immune deficiency) for one (R808) out of three residents reviewed for medication administration.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement fall interventions for three residents (R2, R17, R68) of twelve residents reviewed for falls/accidents resulting in R2 sustaining bruising, swelling, and pain to mid back region of the head, and decline in previous independent ADL's (Activities of Daily Living).

Inspectors wroteThis citation pertains to incident #2667744. Based on observation, interview and record review, the facility failed to protect the resident's right to be free from physical abuse by a resident for four (R60, R74, R142 and R186) of nine residents reviewed for abuse.

Inspectors wroteThis citation has two Deficient Practice Statements (DPS). DPS #1This citation pertains to intake #'s 2642115 and 2661022. Based on observation, interview, and record review, the facility failed to ensure scheduled IV (intravenous) antibiotics were administered per physician's orders for two residents (R#'s 185 and 183) of two residents reviewed for IV antibiotics resulting in verbalized complaints, frustration, delayed treatment for infections, and the potential for an extended stay due to missed medication doses.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure proper storage of medications and biologicals for four of four medication carts reviewed for medication storage.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement appropriate infection control practices relating to laundry service and transmission based precautions for one resident (R185), of one resident reviewed for transmission based precautions, resulting in the spread of infection. Due to faulty infection control practices in the laundry, this his deficient practice had the potential to affect all residents residing in the facility. On 12/9/25 and 12/10/25, multiple observations of R185's room revealed a sign that indicated they were on contact isolation precautions (transmission based precaution that requires the use of an isolation gown and gloves when entering the room) as well as personal protective equipment (isolation gowns, gloves, masks, face shields) for use located in the hallway next to R185's room. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to thoroughly inventory and document personal belongings upon admission for one resident (R123), of one resident reviewed for personal belongings, resulting in the potential for denial of replacement of missing items and valuables.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the call light was in reach for one resident (R114), of one resident reviewed for accommodation of needs, resulting in verbalized frustration and the potential for a delay in staff response to resident needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their grievance process for one resident (R185) of one resident reviewed for grievances, resulting in verbalized complaints and unresolved grievances.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure allegations of abuse were reported to the Administrator/Abuse coordinator and to the State Agency for one R (68) of nine residents reviewed for abuse.

Inspectors wroteBased on observation, interview, and record review, the facility failed to initiate their bowel protocol for one resident (R123) of one resident reviewed for bowel and bladder, resulting in constipation and verbalized complaints of pain and discomfort.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dressings were changed in a timely manner for a peripherally inserted central catheter for one resident (R185), of one resident reviewed for peripherally inserted central catheters, resulting in the potential for the development of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure adequate documentation/monitoring of suctioning administration and cleaning were followed for one resident (R46) of one resident reviewed for oral suctioning.

Inspectors wroteBased on interview and record review the facility failed to maintain complete and accurate electronic medical records for two (R60 and R142) of two residents reviewed for medical records.

Inspectors wroteThis citation pertains to intake 2600758Based on interview and record review the facility failed to ensure timely administration of an ordered and requested pain medication (Oxycodone) for one resident (R101) of one reviewed for pain.

Inspectors wroteThis citatoin pertains to intake #MI00152841. Based on interview, and record review, the facility failed to ensure a resident was free from significant medication errors for one (R803) of four residents reviewed for medication administration, resulting in a significant change in condition and hospitalization when R803 received R801's medications.

Inspectors wroteThis citation pertains to intake #MI00152565. Based on interview and record review, the facility failed to ensure sufficient Nursing staff were available to meet resident medical and supervision needs for 15 residents (R901 and R907) and 13 anonymous residents residing on Mum Unit 2, resulting in delayed medication administration and inadequate resident supervision.

Inspectors wroteThis citation pertains to intake #MI00152565 Based on observation, interview and record review, the facility failed to report allegations of abuse/mistreatment to the State Agency (SA) involving two residents (R901 and R907) of three residents reviewed for abuse/neglect/mistreatment.

Inspectors wroteThis citation pertains to intake #MI00151369 Based on interview and record review, the facility failed to timely address a change of condition for one resident (R#904) of one resident reviewed for a change of condition, resulting in delayed treatment, and failed to ensure the necessary documentation was completed to obtain a medically necessary power tilt recline wheelchair for one Resident (R#905) of two reviewed for rehab services.

Inspectors wroteThis citation pertains to intake #MI00151369 Based on interview and record review, the facility failed to ensure timely laboratory services for one resident (R904) of one resident reviewed for laboratory services, resulting in a delay for the treatment of a urinary tract infection.

Inspectors wroteThis citation pertains to intake MI00149526 Based on interview and record review, the facility failed to ensure administration of an enteral tube feeding (a liquid form of nourishment that is delivered via a surgically inserted tube into the body) in accordance with a Physician order for one (R906) of five reviewed for hydration, resulting in the increased potential for dehydration and clinical compromise.

Inspectors wroteThis citation pertains to intake #'s MI00146852 and MI00146901. Base on observation, interview and record review, the facility failed to ensure a timely investigation of a fall, complete a safe transfer, provide urinary assistance per the plan of care and provide appropriate supervision and interventions to prevent falls for two residents (R35 and R119) resulting in R119 sustaining an acute subcapital left femoral neck fracture.

Inspectors wroteThis citation Pertains to intake #: MI00146952 Based on observation and interview, the facility failed to effectively maintain the resident call system that had capability to directly alert the caregivers and or there were no audible or visual alerts systems for care givers which had the potential to affect all 142 residents at the facility. This deficient practice had an increased likelihood for delayed emergency response and/or negative resident outcomes. An initial facility rounds were completed on 9/16/24 at approximately 10:15 AM on the hallway with Rooms 180-195. There was a computer monitor on the hallway mounted on the wall. This Surveyor observed staff members periodically walking to the monitor to check and when the surveyor asked what it was (that they were looking at) staff members reported that was the call light monitor. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure nursing staff adhered to professional standards for three (R81, R53 and R16) of seven reviewed for medication administration.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide activity of daily living care including showers for one (R27) of three residents reviewed for activities of daily living.

Inspectors wroteBased on observations, interviews and record reviews the facility failed to consistently ensure infection control standards, practices and protocols were consistently followed by the facility staff for six (R's 136, 110, 122, 102, 139 & 119) of 28 sampled residents, this deficient practice had the ability to affect all residents residing in the facility at the time of the survey.

Inspectors wroteThis citation pertains to Intake #: MI00146952 Based on interview and record review facility failed to document and promptly resolve grievances reported to the facility staff for one (R79) of one Resident reviewed for grievances.

Inspectors wroteThis citation pertains to Intake #MI00146952 Based on observation, interview, and record review, the facility failed to obtain a podiatry appointment as ordered after an infection for one (R79) of one Resident reviewed for foot care. This deficient practice has the potential to deteriorate the mobility and overall wellbeing of the resident.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure oxygen was administered per Physician's order and the appropriate cannula was provided and changed for two residents (R149 and R112) of two residents reviewed for respiratory care.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medically related social services were provided for two residents (R16 and R124) of two residents reviewed for Social Services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure accurate reconciliation for controlled medications for two residents (R10, R79) of four reviewed for narcotic storage. On 9/18/24 at 5:10 PM, the North Tulip medication cart, was observed with Register Nurse (RN) CC. A record review of the narcotic binder revealed R10 was administered one tablet of Hydrocodone/Acetaminophen 10/325 milligrams (mg) (a narcotic medication) at 2:26 PM by RN CC and five tablets remained. The blister pack was observed having four tablets. RN CC commented that they were pulled into an isolation room to assist another resident and forgot to administer the medication to R10. On 9/18/24 at 5:30 PM, the Back Mum medication cart was reviewed with RN Y. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure a Physician ordered laboratory (lab) diagnostic was completed for one resident (R149) of one residents reviewed for diagnostics.

Inspectors wroteBased on observation, interview, and record review the facility failed to complete a periodic rehabilitation screening and/or evaluation and initiate maintenance interventions upon discharge for a one (R108) of one Resident reviewed for rehabilitation services resulting in the likelihood for further decline in range of motion, impairment with skin integrity, and increase in pain during Activities of Daily Living (ADL).

Inspectors wroteBased on interview and record review, the facility failed to ensure the pneumonia vaccine was administered after consenting for one (R79) of five sampled residents reviewed for immunizations.

Inspectors wroteBased on interview and record review, the facility failed to ensure the COVID-19 vaccine was offered and timely administered after consent for two (R136, R29) of five sampled residents reviewed for immunizations.

Inspectors wroteThis citation pertains to Intake Number(s): MI00145518 Based on interview and record review, the facility failed to ensure administration of a scheduled long acting antipsychotic medication for one (R601) of three residents reviewed for medication administration.

Inspectors wroteThis citation pertains to intake #MI00142965, and MI00139952. Based on observation, interview and record review, the facility failed to ensure the required assistance level for bed mobility was provided to one (R913) of four residents reviewed for accidents.

Inspectors wroteThis citation pertains to intake #MI00142965 Based on interview and record review, the facility failed to ensure physician ordered laboratory tests were completed for one (R910) of one resident reviewed for laboratory services.

Inspectors wroteR522 On 8/29/23 at 10:42 AM, R522 was up to their Broda Chair in the common/dining area of the memory care unit. They were observed to be seated in the chair with no specialized cushion for offloading pressure and no soft heel boots in place to protect the feet from skin breakdown. On 8/29/23 at 12:37 PM, R522 was observed eating their lunch meal in the dining room. No offloading cushion or heel boots were observed in place at that time. An observation of their room revealed soft heel boots were placed on the stripped bed. On 8/29/23 at 12:48 PM, a review of R522's clinical record revealed they admitted to the facility on [DATE] with diagnoses that included: late onset Alzheimer's disease, dementia, protein calorie malnutrition, anxiety disorder, and falls. [...]

Inspectors wroteThis citation pertains to intake #138289 Based on interview and record review the facility failed to ensure adequate supervision was provided for three cognitively impaired residents (R80, R88 and R110) of seven residents reviewed for accidents, when on 6/15/23 R80 followed by R110 and R88 wandered into another resident room, (unsupervised by staff) which resulted in R110 pushing R88 over and R88 sustaining a nondisplaced fracture of the femoral neck, hospitalization requiring surgery and pain.

Inspectors wroteThis citation pertains to intakes: MI00138638, MI00137343. Based on observation and interview, the facility failed to maintain a sanitary and odor free environment, and maintain the physical environment in good repair, resulting in offensive odors and a non-homelike environment, affecting all residents in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain a pest free environment, and maintain the facility free of pest harborage conditions, resulting in presence of pest, affecting all residents who consume food from the kitchen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to honor resident's food preferences for four residents (R#'s 26, 62, 28, and 18) of 11 residents reviewed for food preferences, resulting in verbalized feelings of frustration.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure medications were appropriately stored in two of three medication carts and ensure one cart was locked, resulting in the potential for unauthorized entry, misuse and possible diversion of medications by staff, visitors, and residents.

Inspectors wroteBased on interview and record review, the facility failed to maintain an effective Antibiotic Stewardship program that included consistent implementation of protocols for appropriate antibiotic administration and ensured that infection criteria were met for six (R92, R95, R104, R70, R75 and R50) residents resulting in the potential for unnecessary antibiotic usage and the development of multiple drug resistant organisms.

Inspectors wroteBased on observation and interview, the facility failed to maintain ventilation, resulting in offensive odors and potential for breathing difficulties for residents, affecting residents on the Tulip hall. Findings Include: On 8/29/23 at 1:57 PM, the bathroom of room [ROOM NUMBER] was observed to have an offensive musty odor. At this time, the exhaust ventilation was tested using a paper towel held against the exhaust grid to see if the vent had sufficient air flow and the vent was observed to not be able to hold the paper towel, showing potential for non-functioning exhaust. On 8/29/23 at 2:00 PM, the bathroom of room [ROOM NUMBER] was observed to have an offensive urine odor. [...]

Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure timely formulation of advance directives and code status according to resident's wishes for one (R117) of three residents reviewed for advance directives with potential for resident preferences for medical care to not be followed by the facility.

Inspectors wroteBased on observation, interview and record review the facility failed to report to the State Agency (SA) an allegation of resident to resident physical abuse for one (R74) of three residents reviewed for abuse.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow up timely and obtain specialist follow up appointments as ordered for two (R84 and R92) of two Residents reviewed for follow up appointments and coordination of care with external providers.

Inspectors wroteBased on interview and record review the facility failed to ensure three Certified Nursing Assistants (CNA's T, U and V) out of five CNAs reviewed for education had completed the required annual competency evaluation, including demonstration in skills and techniques necessary to care for residents. This deficient practice had the potential to affect all residents that resided in the facility.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure timely assessment and follow-up interventions by behavioral health services were provided for two (R84 and R117) of three Residents reviewed for mood and behavior, resulting in delayed and/or unmet emotional and psycho-social well-being care needs and increased potential for direct care staff to be unaware of how to address the behaviors with further likelihood of unmet care needs. R117 R117 was admitted to the facility on [DATE] for short term for skilled nursing and rehabilitation services. R117's admitting diagnoses included quadriplegia after recent spinal cord injury with 7th cervical vertebrae fracture with cervical fusion after fall from stairs at home, major depressive disorder, bipolar disorder, Attention Deficit Hyperactivity Disorder (ADHD), and history of substance abuse. [...]

Inspectors wroteBased on interview and record review, the facility failed to review the recommendations as stated on the Medication Regimen Review (MMR) for one (R71) of five residents reviewed for unnecessary medication resulting in the potential for adverse reactions from unnecessary medications.

Inspectors wroteBased on interview and record review, the facility failed to operationalize an antibiotic stewardship program which ensured appropriate clinical justification for the use of an antibiotic medication and the continuance of unnecessary antibiotics for one (R92) of six residents reviewed for unnecessary antibiotics.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure timely follow through of an oral surgery referral for dental extractions was made for one resident (R63) of two residents reviewed for dental services resulting in a delay for oral surgery.

Inspectors wroteBased on interview and record review the facility failed to ensure that two (R17 and R111) residents/legal responsible representatives received a clear understanding of the facility's Binding Arbitration agreement prior to signing the document and ensured that the representative had the legal ability to sign the document.