Medilodge of Milford

Inspectors wroteBased on observation, interview, and record review, the facility failed to properly use a Hoyer mechanical lift to transfer one resident (R51) of two residents reviewed for accidents, resulting in the mechanical lift falling on R51 causing a laceration to their head requiring a trip to the emergency room for imaging and treatment with staples to close the wound.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement timely preventative interventions for pressure injury for one (R30) of one Resident reviewed for pressure injury prevention/management.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure social work services were implemented in a timely and efficient manner for one (R7) out of one resident reviewed for Social Service/Advanced Directives.

Inspectors wroteThis citation pertains to Intakes: MI00146265 and MI00148408. Based on observation, interview, and record review, the facility failed to ensure fall precautions were implemented for one resident (R904) with a history of falls out of three residents reviewed for falls resulting in the potential for recurrence of falls and injury.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide nursing care and services according to professional standards of practice for one (R203) of one resident reviewed for tube feeding.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accurately assess wounds, perform wound care treatments, coordinate with a comprehensive wound care team consisting of a wound care practitioner, document treatment plans, and implement physician's orders for wound care treatments for two residents, (R#'s 101 and 305) of three residents reviewed for skin impairments, resulting in verbalized complaints, fear of staff competency and infection, and R101 voluntarily leaving the facility for wound care at the hospital.

Inspectors wroteBased on observation, interview, and record review, the facility failed to timely assess pressure ulcers present on admission into the facility in a timely manner, and implement preventative measures to maintain skin integrity for one (R203) of two residents reviewed for pressure ulcers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a thorough and accurate assessment was done upon admission, physician's orders for an indwelling urinary catheter were in place, and the catheter was securely anchored for one (R204) of three residents reviewed for urinary catheters.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate care was provided to prevent dislodgement of a PEG (Percutaneous Endoscopic Gastrostomy) tube (a tube surgically placed into the stomach to deliver nutrition), physicians orders for nutrition and hydration were in place, and care to the PEG tube site was provided according to physician's orders for one (R203) of one resident reviewed for tube feeding, resulting in the PEG tube being torn from R203's stomach requiring a hospital transfer, the potential for poor nutritional and hydration status, pain, infection and skin breakdown.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a physician and/or physician extender evaluated and assessed a new/worsened pressure ulcer for one (R85) of two residents reviewed for pressure ulcers, resulting in the lack of pressure ulcer assessment by the physician, and the potential for inconsistent and timely documentation of wound status, and/or decline of the wound.

Inspectors wroteBased on interview and record review, the facility failed to ensure labs were obtained timely for one resident (R40) of one resident reviewed for labs, resulting in the potential for unmet medical care needs.

Inspectors wroteBased on observation, interview and record review the facility failed to follow infection control guidance for one resident (R306) of three residents reviewed for urinary catheters.

Inspectors wroteThis citation pertains to Intake MI 00133995 Based on observation, interview and record review, the facility failed to ensure timely interventions to reduce the risk of pressure ulcer development, perform accurate and timely skin assessments and ensure orders were clarified for one (R38) of four residents reviewed for pressure ulcers, resulting in R38 acquiring a device related pressure ulcer on the spine. Findings Include: R 38 On 9/12/23 at 9:50 AM, R38 was observed lying in bed on her back sleeping. Padded boots were observed in a wheelchair against the wall across from the bed. R38 was asked if they had any wounds or sores on their body. R38's Family Member present in the room explained R38 had a wound on her ankle and a wound on her back from a back brace. [...]

Inspectors wroteThis citation pertains to intake #'s MI00131500. Based on observation, interview, and record review, the facility failed to ensure adequate interventions to prevent weight loss for one resident (R90) of five residents reviewed for nutrition, resulting in a 15.69% weight loss from June 2023 to August 2023.

Inspectors wroteBased on interview and record review the facility failed to ensure a legally authorized resident representative signed a DNR (do not resuscitate) form (part of an advance directive) for one resident (R72) of one resident reviewed for advance directives.

Inspectors wroteThis citation pertains to intake #'s MI00131529 and MI00138838. Based on interview, and record review, the facility failed to ensure family notification was made for a change of condition for one resident (R104), of two residents reviewed for notification of changes.

Inspectors wroteThis citation pertains to intake #MI00138838 Based on interview and record review, the facility failed to document and follow up on family grievances for one resident (R#104) of one resident reviewed for grievances, resulting in feelings of frustration.

Inspectors wroteBased on observation, interview and record review, the facility failed to implement a comprehensive care plan for one (R95), of one residents reviewed for dialysis care plans.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medications were available for administration for one residents (R59) of one residents reviewed for Nursing standards of practice.

Inspectors wroteBased on observations, interview, and record review, the facility failed to implement interventions to maintain or prevent further decline in range of motion for one (R14) of one Resident reviewed for range of motion and positioning resulting in a potential for further decline in range of motion or worsening of contractures.

Inspectors wroteThis citation pertains to intake #MI00131529 Based on observation, interview and record review the facility failed to ensure interventions to reduce falls were implemented for one resident (R59) of eight residents reviewed for accidents/hazards.

Inspectors wroteThis citation pertains to intake #'s MI00131500 and MI00131529. Based on observation, interview, and record review, the facility failed to ensure resident food preferences for two residents, (R62 and R41) and three residents from the group meeting who wished to remain anonymous, of 17 residents reviewed for dining, resulting in verbalized complaints and disappointment with meals.

Inspectors wroteBased on observation, interview, and record review the facility failed to complete a timely rehabilitation screening and/or evaluation and initiate interventions for a one resident (R14) of one reviewed for impaired mobility, 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 that two (R4 and R51) 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.

Inspectors wroteThis citation pertains to intake #MI00131529 Based on observation, interview and record review the facility failed to ensure a clean/comfortable and homelike environment for two residents (R30 and R72) of two residents reviewed for the Physical environment.