Medilodge of West Bloomfield

Inspectors wroteThis citation pertains to Intake Number(s): 3034017. Based on observation, interview, and record review, the facility failed to report an injury of unknown origin to the State Agency for one (R205) of two residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake Number(s): 3034017. Based on observation, interview, and record review, the facility failed to thoroughly investigate an allegation of verbal and physical abuse by a staff member for one (R205) of two residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake Number(s): 3041709 and 3040038. Based on observation, interview, and record review, the facility failed to conduct ongoing and complete skin assessments and administer treatment according to physician's orders for two (R204 and R205) of three residents reviewed for wounds.

Inspectors wroteThis citation pertains to Intake Number(s): 3041709 and 3040038. Based on interview and record review, the facility failed to conduct thorough and accurate skin assessments, ensure timely evaluation of existing pressure ulcers by a wound provider, administer wound treatments as ordered by the physician, and implement treatments in a timely manner for two (R203 and R204) of three residents reviewed for wounds.

Inspectors wroteThis citation pertains to Intake 2659810. Based on observation, interview, and record reviews the facility failed to ensure infection control standards and practices were consistently implemented by the facility staff and failed to implement an effective infection control surveillance program.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were treated with dignity and respect for two (R59 and R68) of three residents reviewed for dignity, including multiple anonymous residents that attended the confidential resident council interview.

Inspectors wroteThis citation pertains to intakes 2659810 and 2718805. Based on observation, interview and record review, the facility failed to maintain a clean, comfortable, safe, and homelike environment, affecting all residents that access the ice machine and shower room.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an environment free from accident hazards related to resident smoking and storage of smoking paraphernalia for three (R3, R5 and R88) of five residents reviewed for accidents and multiple residents that attended the confidential resident council interview.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure expired medications were discarded from one medication storage room of two medication storage rooms reviewed.

Inspectors wroteBased on interview, and record review, the facility failed to monitor appropriate use of antibiotics for one (R14) of three reviewed for antibiotic stewardship program to ensure all resident's prescribed antibiotics are monitored for the right indication, dose, and duration.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an emergency pull cord to was available within the immediate shower area (accessible if lying on the floor) for two shower stalls, affecting all residents that utilize the C/D shower room.

Inspectors wroteThis citation pertains to Intake 2561059. Based on interview and record review, the facility failed to honor a full code advance directive for one (R146) of one reviewed, who wanted to receive all possible medical interventions in the event of a cardiac or respiratory arrest. R146 was found unresponsive, was not provided cardiopulmonary resuscitation (CPR) or other life saving measures as elected in their advance directives.

Inspectors wroteBased on interview and record review the facility failed to ensure the appropriate Notice of Medicare Non-Coverage (NOMNC) and a Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) were provided and completed for three (R10, R127 and R164) of three residents reviewed for beneficiary notification, resulting in the residents and/or representatives to be uninformed of the potential private pay charges for continued services at the facility, and the inability to file an appeal.

Inspectors wroteThis citation pertains to intake 2621417. Based on interview and record review, the facility failed to ensure a safe discharge for one resident (R144) of two residents reviewed for discharge planning.

Inspectors wroteBased on interview and record review, the facility failed to submit a notification of transfer to the state ombudsman's office for one resident (R141) of one resident reviewed for hospitalization.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review (PASARR) Level II evaluation (community mental health assessment) was completed and implemented within the resident's plan of care for one (R3) of one resident reviewed for PASARR.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the facility nurses consistently followed the standards of practice for the administration and documentation of a controlled medication observed for the medication administration (R65) and failed to ensure that physicians orders were transcribed and carried out as ordered for one (R162) resident of three residents reviewed for closed records.

Inspectors wroteBased on observation, interview and record reviews the facility failed to ensure the coordination of a Cardiology appointment and failed to communicate with the legal guardian for one (R9) of one resident reviewed for the coordination of medical appointments.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure appropriate catheter care was provided for one resident (R6) of one resident reviewed for indwelling catheters.

Inspectors wroteThis citation pertains to intakes 2696875 and 2718805. Based on interview, and record review, the facility failed ensure provision of medically-related social services regarding psychosocial well-being post abuse allegations, resident-to-resident incidents, and/or changes in mood/behavioral concerns for two (R35 and R49) of two residents reviewed for behavioral/emotional needs.

Inspectors wroteThis citation pertains to Intake #2621426Based on observation, interview and record review the facility failed to ensure accurate and timely medication administration was provided to a resident who required seizure medication for one (R43) out of seven residents reviewed for medication administration.

Inspectors wroteBased on interview, observation and record review the facility failed to ensure residents received a clear understanding of the facility's binding arbitration agreement for three (R60, R103 and R152) out of 72 residents reviewed for Binding Arbitration.

Inspectors wroteThis citation pertains to complaint: 2641546. Based on interviews and record reviews the facility failed to develop an adequate safety plan, failed to consistently implement the plan of care and adequate supervision for one (R127) of one resident reviewed for falls with injury, resulting in multiple injuries that included: a hematoma to the right side of forehead, bruise to the right shoulder, pain, bruising/edema to the right eye, laceration to the left side of forehead, a small focus of extra-axial hemorrhage along the anterior left frontal lobe (minor collection of blood outside the brain tissue) and required a transfer to the Emergency Department (ED) for further evaluation.

Inspectors wroteThis citation pertains to Incident #2588421. Based on observation, interview, and record review, the facility failed to assess resident's skin on a regular basis and thoroughly assess a new skin tear and bruise for one (R702) of two residents reviewed for skin management.

Inspectors wroteThis citation pertains to intakes MI00153326, MI00153330, MI00153348. Based on interview and record review, the facility failed to ensure an allegation of physical abuse was reported to the State Agency for one resident (R803) of two residents reviewed for abuse.

Inspectors wroteThis citation pertains to intake: MI00152471. Based on interview and record review the facility failed to consistently assess, monitor, and review the nutritional needs and ensure adequate interventions were consistently implemented and/or modified to prevent further weight loss for one (R305) of three residents reviewed for nutrition, resulting in a severe weight loss of -15.05 lbs (pounds) within four weeks of admission.

Inspectors wroteThis citation pertains to intake #MI00152154. Based on observation, interview, and record review the facility failed to thoroughly investigate an allegation of sexual abuse for one resident (R304) of three residents reviewed for abuse, resulting in the potential for unidentified instances of abuse.

Inspectors wroteThis citation pertains to Intake Number(s): MI00151843. Based on interview and record review, the facility failed to assess a resident timely after a fall, document the fall in a timely manner, and investigate to determine the root cause of the fall for one (R303) of two residents reviewed for falls.

Inspectors wroteThis citation pertains to intake: MI00152471. Based on interview and record reviews, the facility failed to obtain STAT (immediate) labs ordered by the physician for a resident identified with a change of condition for one (R305) of one resident reviewed for lab services.

Inspectors wroteThis citation pertains to Intake Number(s): MI00148496 Based on interviews and record reviews the facility failed to maintain on effective infection control prevention and control program for 82 of 82 residents who resided in the facility.

Inspectors wroteThis citation pertains to intake #'s MI00149476 and MI00149540. Based on interview and record review the facility failed to keep service reports and ensure regular inspections of the domestic hot water boilers to maintain proper functioning of the hot water supply were completed in a timely manner potentially affecting all 82 residents who reside in the facility.

Inspectors wroteThis citation pertains to Intake Number(s): MI00148496. Based on interview and record review, the facility failed to ensure the physician evaluated the total program of care to include a newly developed skin impairment for one (R802) of one residents reviewed for physician visits.

Inspectors wroteThis citation pertains to intake# MI00149540. Based on observation, interview and record review, the facility failed to ensure activities of daily living (ADL's) including regular bathing and transfers were provided for one resident (R803) of one resident reviewed for activities of daily living (ADL's).

Inspectors wroteThis citation pertains to Intake Number(s): MI00148496. Based on interview and record review, the facility failed to identify, monitor, and assess a skin impairment and provide follow up after an outside appointment for one (R802) of one resident reviewed for skin impairments.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure personal clothing items that were sent to laundry were returned to the residents in a timely matter. This deficient practice has the potential to affect all residents sending clothing items to laundry, including residents who attended a resident council meeting who asked to remain anonymous.

Inspectors wroteBased on observation and interview, the facility failed to ensure safe and secure medications from one of two medication carts and one of three refrigerators observed for medication storage and labeling.

Inspectors wroteBased on observation and interview, the facility failed to maintain clean storage of linens and resident clothing in the laundry room resulting in contamination and build up of dust and dryer lint.

Inspectors wroteThis citation pertains to intake# MI00142611. Based on interview and record review the facility failed to protect the resident's right to be free from verbal abuse by facility staff for one resident (R901) of two residents reviewed for abuse.

Inspectors wroteThis citation pertains to intake # MI00140255. Based on interview and record review, the facility failed to ensure a resident's change in condition was immediately reported, monitored, and had timely interventions implemented to address these changes for one (R804) of three residents reviewed for change in condition, resulting in delayed follow-up care, and delayed hospitalization for treatment following observations of the resident's right lower extremity being cold to the touch, with two plus pitting edema following a surgical repair two weeks earlier; and a fall with subsequent dislocated metallic prosthesis on the right hip.

Inspectors wroteThis citation pertains to Intake Number(s): MI00136540, MI00138044, MI00135715, and MI00140171. Based on observation, interview, and record review, the facility failed to conduct an accurate fall risk assessment and implement effective interventions to prevent falls for three (R100, R16, and R92) of five residents reviewed for falls, resulting in R100 being transferred to the hospital two times on the same day after falls that resulted in a rib fracture, skin tear, and a laceration to the left side of the head that required sutures; R16 falling out of bed and being transferred to the hospital with a hematoma to the forehead; and R92 sustaining a traumatic posterior scalp hematoma and abrasion which required an emergency transfer to the hospital.

Inspectors wroteThis citation pertains to intake #s: MI00135137, MI00136540, MI00137861 and MI00137525. Based on observation, interview and record review, the facility failed to ensure nine residents (R12, R16, R17, R20, R40, R43, R67, R72, and R91) of ten residents reviewed dignity, and multiple residents that attended the confidential resident council interview were treated in a dignified manner, resulting in the expressions of frustration, loss of autonomy, and the potential for decreased feelings of self-worth.

Inspectors wroteThis citation pertains to Intake Number: MI00137861 Based on observation, interview and record review the facility failed to ensure the cleanliness of the shared shower room located on the C/D unit for one (R40), anonymous residents attending Resident Council and potentially effect additional residents who used the shared shower located on the unit.

Inspectors wroteThis citation pertains to intake(s): MI00134510 & MI00135137. This citation contains two Deficient Practice Statements (DPS). DPS #1 Based on observations, interviews, and record reviews the facility failed to ensure medications were transcribed and ordered as directed by the physician (R93), failed to administer medications per the physician's order (R's 93 & 46) and ensure a gastroesophageal reflux disease (GERD) medication was administered prior to dinner as requested (R4) for three of three residents reviewed for accurate and timely administration of medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure consistent communication and coordination of care with the dialysis center for one (R85) of two residents reviewed for dialysis.

Inspectors wroteThis citation pertains to intake #MI00135137 Based on observation, interview, and record review the facility failed to ensure resident's food preferences were honored for two residents (R#'s 62 and 489) as well as multiple attendees at the group meeting, resulting in verbalized complaints about the facility's food.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure two (R17 and R71) of two residents reviewed for medications were assessed for the safe self-administration of medication, resulting in the potential for mismanagement of the prescribed medication.

Inspectors wroteBased on observation, interview and record review the facility failed to accommodate a preference for the Physical Therapy scheduled sessions for one resident (R489) of one resident reviewed for choices.

Inspectors wroteThis citation pertains to Intake Number: MI00135231. Based on observation, interview and record review the facility failed to ensure a comprehensive plan of care was updated and revised to reflect resident centered and individualized areas of care for two residents (R11 and R392) of two residents reviewed for comprehensive care plans.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medication was administered appropriately for one resident (R388) of one resident reviewed for Nursing standards of practice.

Inspectors wroteThis citation pertains to Intake Number(s): MI00135715. Based on observation, interview, and record review, the facility failed to ensure restorative services to prevent functional decline for one resident (R24) of five residents reviewed for restorative services resulting in activity of daily living functional declines.

Inspectors wroteThis citation pertains to intake #MI00135231. Based on interview and record review, the facility failed to ensure a clinical indication for the use of an indwelling urinary catheter and an assessment and trial discontinuation for a urinary catheter in the absence of a clinical indication for one resident (R94) of one resident reviewed for urinary catheters.

Inspectors wroteThis citation pertains to intake # MI00136540. Based on observation, interview and record review, the facility failed to order routine colostomy care for one (R11) of one resident reviewed for colostomy care, resulting in the potential for inadequate assessment and treatment of unrecognized skin and/or stoma problems.

Inspectors wroteThis citation pertains to Intake Number(s): MI00135715. Based on observation, interview and record review the facility failed to ensure one resident (R392) had Physician orders for oxygen therapy of three residents reviewed for respiratory care.

Inspectors wroteThis citation pertains to intake #MI00138044 and MI00136540. Based on interview and record review the facility failed to ensure as needed pain medication was administered for one resident (R95) of three residents reviewed for pain.

Inspectors wroteBased on interview and record review, the facility failed to ensure timely coordination of behavioral health services for one (R11) of one resident reviewed for mood and behavior.

Inspectors wroteBased on interview and record review, the facility failed to ensure a resident (R11) who was prescribed antipsychotic medication had adequate indication for continued use, had adequate monitoring and identification of resident-specific targeted behaviors, and had timely gradual dose reductions (GDR) attempted in absence of supporting documentation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an insulin pen was labeled with the resident's name and prescribing information and ensure it was removed from the medication cart when expired in one of two medication carts reviewed.

Inspectors wroteBased on interview and record review the facility failed to implement an effective antibiotic stewardship program that included consistent implementation of protocols for appropriate antibiotic use for three (R's 438, 33 and 42), this deficient practice had the ability to affect multiple residents who were prescribed antibiotics during their inpatient care at the facility.