Midland Medical Lodge

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure the resident resided and received services in the facility with reasonable accommodation of resident needs and preferences for 6 of 28 residents (#11, #37, #83, #87, #96 and #103) who were reviewed for call light response and within reach in that the facility. 1. The facility failed to place Residents #11, #87 and #96's call lights within reach. 2. The facility failed to deliver timely call light response for Residents #37, #83 and #103. This deficient practice could affect residents who receive care at the facility and could result in missed or inadequate care.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 2 (Residents #11 and #71) of 5 residents reviewed for infection control in that: The facility failed to ensure LVN B used PPE during PEG tube (percutaneous endoscopic gastrostomy tube-a feeding tube inserted through the abdominal wall into the stomach) care for Resident #11 as the resident was on EBP (enhanced barrier precautions). The facility failed to ensure LVN B sanitized the glucometer with an appropriate sanitizing item after performing a blood sugar test on Resident #71. These failures could place residents at risk for cross contamination and the spread of infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one of seven residents (Resident #23) reviewed for quality of care. The facility failed to provide wound care for Resident #23 using professional wound care standards and failed to follow the physician's treatment order. This failure could place residents at risk of improper wound management, deterioration in existing wounds, leading to infection and pain.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure resident equipment was maintained in a safe, operating condition for 1 of 7 residents reviewed for wheelchair safety. The facility failed to ensure that Resident #62's wheelchair brakes operated. This failure placed residents at risk for unsafe transfers and/or falls if wheelchair rolled out from under the resident during transfers.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, and dispensing of routine drugs and biologicals to meet the needs of each resident for 1of 7 residents reviewed for pharmacy services. (Resident #23) The facility failed to ensure Resident #23's ordered Rifampin (antimicrobial drug used to manage and treat diverse mycobacterial infections and gram-positive bacterial infections) medication was available for administration from 8/8/2025-8/20/25. The facility did not notify physician of unavailability until after resident missed 12 doses of Rifampin. These failures could place residents at risk for not receiving medications as prescribed and a decline in health status.

Inspectors wroteBased on observation, interview and record review the facility failed to store all drugs and biologicals in locked compartments for 1 of 4 nurse medication carts (Hall 200 cart) reviewed for medication storage and security. The 200-hall nurse medication cart was left unlocked while unsupervised. These failures could place clients at risk for drug diversion or accidental ingestion.

Inspectors wroteBased on interview and record review, the facility failed to ensure an accurate MDS was completed for 3 of 22 residents (Residents #33, #37, and #41) reviewed for MDS assessment accuracy. 1. The facility failed to accurately address Resident #33's tracheostomy status on her Quarterly MDS assessment. 2. The facility failed to accurately address Resident #37's use of insulin on her Quarterly MDS assessment. 3. The facility failed to accurately address Resident #41's dependence on dialysis on her admission MDS assessment. The failures could place residents at risk for not receiving care and services to meet their needs.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 22 residents (Resident #85) reviewed for care plans. 1. The facility failed to have a care plan in place to accurately address Resident #85's code status. This failure could affect residents by placing them at risk of not receiving individualized care and services to meet their needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 3 residents reviewed for accident hazards/supervision (Resident #23). The facility failed to ensure CNAs B and C demonstrated appropriate transfer techniques while using the mechanical lift for Resident #23. The failure could place residents at risk for injuries.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that a resident who was fed by enteral means received the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers for one of two residents (Resident #74) reviewed for enteral feedings. The head of the bed was not kept elevated above 30 degrees for Resident #74 to prevent aspiration pneumonia. This failure could place residents who are fed by enteral means at an increased risk for complications including, but not limited to, aspiration pneumonia (pneumonia caused by breathing foreign objects breathed into the lungs).

Inspectors wroteBased on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for professional standards for food service safety. - There was 1 bag of frozen of pizza sausages located in the walk-in freezer that was removed from the original package and not dated or labeled with contents. -There was 1 sealed storage bag of approximately 10-12 pork chops removed from the original package without a label of its contents -There was 1 sealed storage bag of chopped carrots removed from the original package without a label of its contents. -There was 1 sealed storage bag of cooked bacon removed from the original package without a label of its contents. -Dietary Aide L not wearing a beard net while in the kitchen. [...]

Inspectors wroteBased on observation and interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure stored foods were properly labeled and dated. The facility failed to ensure that expired foods were discarded. These failures could place residents who received prepared meals from the kitchen at risk for food borne illness and cross-contamination.

Inspectors wroteBased on observation, interview, and record review the facility failed to treat residents with respect, dignity and care for each resident in a manner that promotes maintenance or enhancement of his or her quality of life for 13 of 13 residents in the confidential group interview. Staff used cell phones in residents' presence causing residents to feel disrespected. Staff told residents to go to the bathroom on themselves and the residents would be changed later. This failure resulted in a diminished quality of life for the identified residents and could affect additional residents by causing a loss of self-esteem and increased isolation.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 2 of 2 residents (Resident #5 and #310) reviewed for accident/hazards/supervision, in that: - LVN E and CNA F transferred resident #310 from his wheelchair to his bed by hooking their arms under the resident's armpits and without the use of a gait belt. - CNA I and CNA H transferred Resident #5 from her bed to her wheelchair by hooking their arms under the resident's armpits and with the improper use of a gait belt. These failures could put residents at risk of accidents and serious injuries which could result in a reduced quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 3 of 10 residents reviewed for pharmacy services (Residents # 15, #34, #43) during review of medication carts. -Warfarin 6mg tab card expired 5/1/23, prescribed to resident #34 -Warfarin 10mg card expired 4/24/23, prescribed to resident #34 -Ondansetron 4mg expired 4/13/23, prescribed to resident #15 -Ondansetron 4mg expired 5/9/23, prescribed to resident #15 -Ondansetron 4mg expired 5/13/23, prescribed to resident #43 -Hydralazine 10mg expired 5/13/23, prescribed to resident #43 This failure could place residents at risk of receiving medications that were expired and not produce the desired effect.

Inspectors wroteBased on observation, interview, and record review the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for 1 medication (cart #3) of 4 medication carts reviewed and 1 of 1 treatment carts reviewed for label and storage of drugs and biologicals. The facility failed to ensure medication cart #3 was locked when unattended. The facility failed to ensure that treatment cart 1 of 1 was locked when unattended. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm or drug diversions.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to prevent the development and transmission of disease and infection for 4 of 10 residents observed for infection control. MA C dropped Resident #77's medication on the medication cart then proceeded to pick it up with her bare hands and placed it in the medication cup to be administered to the resident. MA C failed to wash hands prior to administration of medications. MA C measured blood pressures on two consecutive residents (#60,#65), failing to wipe off the blood pressure cuff between residents. MA C administered nasal spray to Resident #60 with bare hands, failed to wash hands prior to or after procedure. CNA A double gloved during incontinent care for Resident #1 and did not sanitize her hands when going from dirty to clean. [...]