Optalis Health & Rehabilitation of Bloomfield Hill

Inspectors wroteThis citation relates to Intake 3054948. Based on observation, interview, and record review, the facility failed to ensure the proper preparation of purred food related to the kitchen tray prep line for one Resident (R701) of one resident reviewed resulting in a choking incident.

Inspectors wroteThis citation relates to Intake 3065617. Based on observation, interview, and record review, the facility failed to provide dignified care and privacy for one Resident (R704) of four residents reviewed for dignity.

Inspectors wroteThis citation relates to Intake 3065617. Based on observation, interview, and record review, the facility failed to ensure call lights were in reach for two Residents (R701, R704) of four residents reviewed for accommodation of needs.

Inspectors wroteThis citation relates to Intake 3065617. Based on observation, interview, and record review, the facility failed to ensure documentation of a physician order for wound treatment for one Resident (R703) of three residents reviewed for skin and wound care, resulting in the delayed documentation of a physician order for an unstageable pressure injury and the potential for missed treatments.

Inspectors wroteThis citation relates to Intake 3054948. Based on observation, interview, and record review, the facility failed to prevent an avoidable choking incident for one Resident (R701) of four residents reviewed for accidents and incidents.

Inspectors wroteThis citation pertains to Intake Number(s): 2786159 and 2732494. Based on interview and record review, the facility failed to allow readmission into the facility after hospitalization and failed to document the reason for discharge in the medical record for one (R904) of three residents reviewed for inappropriate discharge, resulting in the resident remaining in the hospital for 45 days after they were determined to be stable for discharge.

Inspectors wroteThis citation pertains to intake #2983214 Based on interview and record review the facility failed to issue a notice of discharge and discharge summary for one resident (R901) of two residents reviewed for discharges.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure food items were properly labeled, dated, and stored. This deficient practice had the potential to affect all residents that consume food from the kitchen.

Inspectors wroteBased on observations, interviews and record reviews the facility failed to maintain an ongoing Infection Control Surveillance system and ensure the consistent implementation of the facility's policies and procedures for the Infection Prevention and Control program. This deficient practice had the potential to affect all residents that resided in the facility, including R's 65, 57, 121, 48, 70, 113, 64, 106, 74, 5, 4, 99, and 62 of 13 residents reviewed for Infection Control.

Inspectors wroteThis citation pertains to Intakes 2711600 and 2703853. Based on interview and record review, the facility failed to ensure sufficient nursing staff on the 2 [NAME] Unit for three (R4, R9, R11) residents reviewed, resulting in resident's not receiving their medications according to physician's orders. This had the potential to affect all residents who resided on the 2 [NAME] Unit.

Inspectors wroteBased on observation, interviews and record reviews the facility failed to ensure medications were properly stored and ensure proper disposal of loose medications for three (1 East cart-2, 2 East high hall cart, and 2 East center cart) of four medication carts and for R120, all reviewed for medication storage.

Inspectors wroteBased on interview and record review the facility failed to maintain an effective antibiotic stewardship program to monitor the appropriateness of antibiotic use for two (R's 3 and 104) of two residents reviewed for the antibiotic stewardship.

Inspectors wroteThis citation pertains to Intake 2711600 Based on observation, interview, and record review, the facility failed to ensure one (R5) of one resident reviewed for accommodation of needs had an appropriate call light that they were able to use.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure end of life wishes were accurately and clearly reflected in the medical record for one resident (R4) out one resident reviewed for advanced directives.

Inspectors wroteThis citation pertains to Intake 2711600. Based on observation, interview and record review, the facility failed to maintain a homelike environment for three residents (R5, R9 and R85) of three reviewed for environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to report an injury of unknown origin to the Administrator in a timely manner for one (R80) of five residents reviewed for abuse.

Inspectors wroteThere are two deficient practice statements. Deficient Practice Statement (DPS) #1. This citation pertains to Intake 2703853. Based on interviews and record reviews the facility failed to complete accurate assessments, document accurate vitals in the medical charts, complete labs as ordered, administer medications/intravenous fluids as ordered, and report accurate assessments to the Physician for timely treatment, care and/or transfer to a higher level of care, for three (R's 122, 99 and 4) of four residents reviewed for a change in condition.

Inspectors wroteThis citation pertains to Intake 2690703. Based on observation, interview, and record reviews the facility failed to ensure interventions and treatment were implemented and/or applied consistently for two (R's 120 & 4) of four residents reviewed for pressure wounds.

Inspectors wroteThis citation pertains to Intake 2711600. Based on observation, interview, and record review, the facility failed to ensure interventions were implemented to prevent falls for one (R85) of five residents reviewed for accidents, resulting in additional falls from bed.

Inspectors wroteThis citation pertains to Intake 2711600Based on observation, interview and record review the facility failed to ensure accurate weights were obtained and accurate assessments were completed for one (R64) of six residents reviewed for nutrition resulting in R64's actual weight being 29.6 pounds [Lbs] less than the documented weight indicating severe weight loss.

Inspectors wroteBased on observation, interview and record reviews the facility failed to ensure coordination with meals around dialysis services for one (R120) of two residents reviewed for dialysis.

Inspectors wroteBased on observation, interview and record reviews the facility failed to ensure the timely review of a pharmacist recommendation for one (R65) of five residents reviewed for unnecessary medications.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a medication error rate less than five percent when two medication errors out of 27 opportunities for error were observed for two (R110 and R70) of three residents reviewed during the medication administration observation, resulting in a 7.41% error rate.

Inspectors wroteThis citation pertains to intake: 2662635. Based on observation, interview, and record review the facility failed to consistently notify and update R502's family of newly identified wounds for one (R502) of one resident reviewed for notification/plan of care.

Inspectors wroteThis citation pertains to intake: 2662635. Based on observation, interview and record review the facility failed to report a decline of a sacral/sacrum wound to the physician and implement treatment to an infected wound, for one (R502) of two residents reviewed for pressure wounds.

Inspectors wroteThis citation pertains to intake: 2662635. Based on observation, interview and record review the facility failed to provide indwelling catheter care for one (R502) of one resident reviewed for catheter care.

Inspectors wroteThis citation pertains to intake: 2662635. Based on observation, interview, and record review the facility failed to ensure consistent Percutaneous Endoscopic Gastrostomy (PEG) care was completed for one (R502) of two residents reviewed for PEG maintenance/care.

Inspectors wroteThis citation pertains to Intake 2564545Based on observation and interview, the facility failed to provide a sanitary homelike environment among the first and second floor residential common areas including the second-floor dining rooms, first floor community room, and first floor residential community shower room, resulting in an unkempt environment and potential for resident dissatisfaction with their living conditions and failure to maintain a clean healthcare environment.

Inspectors wroteThis citation pertains to Complaint #1191844. Based on interview and record review, the facility failed to provide access or copies of the resident's medical records to the resident representative within the required timeframe for one (R705) of two residents reviewed for access to medical records.

Inspectors wroteThis citation pertains to intake #'s 1191435 and 1191855. Based on observation, interview and record review, the facility failed to ensure medications were available for administration and arrange a dermatology consultation per the Physician's order for two residents (R701 and R703) of two residents reviewed for Physican orders/Medications.

Inspectors wroteThis citation pertains to Complaint #1191844. Based on interview and record review, the facility failed to provide medically related social services related to obtaining consent for psychotropic medication use and coordination of psychiatric services for one (R705) of four residents reviewed for medications.

Inspectors wroteThis citation pertains to Intake 1191435Based on interview and record review the facility failed to obtain requested and ordered services to be seen by an Oral Surgeon for two surgical teeth extractions to meet a needed escalation of dental care for one resident (R701) of one reviewed for dental services.

Inspectors wroteThis citation pertains to intake #MI00150014 Based on interview and record review the facility failed to ensure medications were administered timely and per resident preference for one resident (R810) of three residents reviewed for medication administration, resulting in verbalized complaints and frustration with medications being administered late. On 3/19/25 at approximately 3:25 PM, an interview was conducted with R810. They verbalized complaints regarding late medication administration times. They said nurses go on their breaks prior to passing medications so they don't get them on time. They said the concern was worse at night and it made them, nervous to not get their seizure medications on time. [...]

Inspectors wroteThis citation pertains to intake #MI00150014 Based on interview and record review the facility failed to notify the responsible party of a change of antipsychotic medication dosage for one resident (R801) of three residents reviewed for notification of changes resulting in complaints they were not informed of the resident's plan of care.

Inspectors wroteThis citation pertains to intake #MI00150014 Based on interview and record review the facility failed to ensure care conferences were coordinated with the inclusion of their responsible party for one resident (R801) of three residents reviewed for care conferences resulting in complaints of not being informed of the resident's plan of care.

Inspectors wroteThis citation pertains to intake #'s MI00150014, MI00150295 Based on observation, interview, and record review facility failed to provide appropriate supervision for one (R804) of one resident reviewed for accidents. This deficient practice had the potential to cause burns and or fire related accidents when facility staff applied a non-medical grade heating pad (brought from home) to R804 with no assessment and physician order.

Inspectors wroteThis citation pertains to intake #'s MI150014, MI00150295, MI00148319 Based on observation, interview, and record review facility failed to provide timely incontinence care for one (R804) of 3 residents reviewed for incontinence care resulting in the potential for impaired skin integrity and urinary tract infection(UTI).

Inspectors wroteThis citation pertains to Intake #MI00148866 Based on observation, interview and record review the facility failed to adhere to a resident's right to decline a urine toxicity test for one resident (R905) of three residents reviewed for resident rights.

Inspectors wroteThis citation pertains to intake #MI00148615 Based on observation, interview and record review, the facility failed to ensure freedom of movement was maintained for one resident (R903 as witnessed by R907 and R908) of three residents reviewed for involuntary seclusion.

Inspectors wroteThis citation pertains to intake #MI00148615 Based on interview and record review, the facility failed to report an allegation of involuntary seclusion in a timely manner to the Administrator and the State Agency for one resident (R903) of three residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake #MI00147295. Based on observation, interview, and record review the facility failed to administer an erythropoietin stimulating agent (ESA-medication that stimulates the bone marrow to produce more red blood cells) as ordered by physician(s) for one (R104) of one Resident reviewed for quality of care resulting resulted in avoidable hospitalizations (due to critically low hemoglobin levels), blood transfusions, with feelings of frustration, helplessness, and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain the kitchen and the 1st and 2nd floor pantry refrigerators in a sanitary manner. This deficient practice had the potential to affect all residents in the facility that consume food.

Inspectors wroteBased on interview and record review, the facility failed to employ a qualified social worker on a full-time basis to meet the psychosocial, mental, and behavioral health care needs of the residents. This deficient practice had the potential to affect all residents that reside within the facility.

Inspectors wroteBased on interview and record review the facility failed to establish an effective Quality Assessment and Assurance (QAA) and Quality Assurance and performance Improvement (QAPI) plan that identified systemic issues that resulted in sub-standard quality of care from failure to employ a qualified full time social worker and failure to provide medically related social services. This deficient practice had the potential to affect all 120 residents of the facility.

Inspectors wroteOn 10/01/24 at 12:20 PM, an observation of the second-floor [NAME] dining room revealed four residents sitting at three different tables. The tabletops were dirty and appeared sticky. The entire carpeted floor was unkept with moderate amounts of crumbs and debris throughout. The kitchen counter displayed areas of brown colored, dried food substance, and debris. Two mirrors on the far wall in between the windows were smudged with fingerprints. Left window vertical blinds were observed broken and bent. Two blue colored fabric lounge chairs were observed with large stains on both seats and arm rests. The middle cabinet of a credenza containing board games was opened and revealed used white Kleenex tissue, a white sheet rolled up with yellow-colored stains and a dirty white bath towel. Lying on the floor next to the credenza, a dusty single black sock was observed. [...]

Inspectors wroteR25 On 10/2/24, clinical record review revealed R25 was admitted to the facility on [DATE] with a medical history of Parkinson's disease, heart disease, and diabetes. Psychiatric diagnoses included dementia, and schizophrenia. R25 had a BIMS score 9/15 indicating moderate cognitive impairment. Record review revealed on 8/20/24, R25 was evaluated determined unable to make medical treatment or financial decisions and guardianship was recommended. Progress note dated 8/16/24 revealed social services contacted R25's daughter and recommended guardianship. The progress note dated 8/21/24 documented social services informed R25's daughter about the results of the capacity evaluation and the determination of inability to participate in complex decision making. The family expressed they will proceed with guardianship. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident prescribed psychotropic medication had adequate documentation to support continued use, as well as identify and monitor resident specific targeted behaviors and approaches for one (R22) of five residents reviewed for unnecessary medication, resulting in prolonged unnecessary use of psychotropic medication and the inability to monitor the effectiveness of the prescribed treatment due to lack of supporting documentation.

Inspectors wroteThis citation pertains to intake #s MI00146078 and MI00147295. Based on observation, interview and record review, the facility failed to provide an environment that promoted and enhanced residents' dignity for one (R22) of five residents reviewed for dignity.

Inspectors wroteBased on observation, interview, and record review facility failed to provide an appropriate wheelchair/Geri-chair (a reclining chair with wheels) for one (R107) of two Residents reviewed for accommodation of needs.

Inspectors wroteThis citation pertains to Intake #MI00147295. Based on interview and record review facility failed to document and promptly resolve grievances reported to the facility staff for one (R104) of one Resident reviewed for grievances.

Inspectors wroteBased on interview and record review, the facility failed to complete an annual OBRA (Omnibus Budget Reconciliation Act) Level II Evaluation for one resident(R33) of one resident reviewed for PASARR (Preadmission Screen and Resident Review).

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop resident-specific comprehensive care plans for one (R22) of three residents reviewed for care planning related to behavior-emotional needs and use of psychotropic medications.

Inspectors wroteThis citations pertains to intake: MI00146611 Based on observation, interview, and record review, the facility failed to secure the smoking materials for one (R15) of one Resident reviewed for smoking resulting in the potential to cause burns from smoking/smoking materials that were unsecured.

Inspectors wroteThis citation pertains to intake #s MI00146249 and MI00147295. Based on observation, interview and record review, the facility failed to maintain a medication error rate of less than five percent. Three medication errors were observed from a total of 36 opportunities for three out of three residents (R19, R03, R83) resulting in an error rate of 8.33%.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents and visitors had access to previous survey results, resulting in residents and visitors being uninformed of deficiencies identified in the facility. This had the potential to affect all residents who resided in the facility.

Inspectors wroteThis citation pertains to Intake Number(s): MI00145592 Based on observation, interview, and record review, the facility failed to promote self-determination and allow one (R802) of three residents reviewed for resident rights, who was his own responsible party, to make his own decision to go on a leave of absence in the community, resulting in the resident feeling angry and distressed about possible loss of personal items in a storage unit after police were called and the facility staff threatened commitment to a psychiatric unit if he tried to leave the facility.

Inspectors wroteThis citation pertains to Intake Number: MI00145554 and MI00145592. Based on observation, interview, and record review, the facility failed to conduct a thorough and accurate skin assessment, clarify discharge instructions from the hospital and facility orders for wound treatment, implement and administer wound treatment according to hospital discharge instructions, and ensure coordination between the wound provider and the surgeon for one (R802) of one resident reviewed for wounds, resulting in infection and the need for antibiotics.

Inspectors wroteThis citation pertains to Intake Number(s): MI00145554 Based on observation, interview, and record review, the facility failed to ensure one (R802) of one resident reviewed for foot care, received physician ordered treatment from a podiatrist.

Inspectors wroteThis citation pertains to Intake Number(s): MI000145412, MI00145592. Based on observation, interview, and record review, the facility failed to provide medically related social services related to competency evaluation, guardianship, discharge planning, and coordinating ancillary services for two (R802 and R804) of three residents reviewed for social services.

Inspectors wroteThis citation pertains to Intake Number(s): MI00144743 and MI00144492 Based on observation, interview, and record review, the facility failed to maintain an environment that was clean, sanitary, and homelike for four (R505, R508, R509, and R510) of five residents reviewed for the environment with the potential to affect all residents who resided on the second floor of the facility.

Inspectors wroteThis citation pertains to Intake Number(s): MI00144772. Based on interview and record review, the facility failed to report an allegation of resident to resident abuse to the State Agency within the required time frame for two (R501 and R502) of four residents reviewed for abuse.

Inspectors wroteThis citation pertains to Intake Number(s): MI00144772. Based on interview and record review, the facility failed to implement adequate supervision for one (R502) of four residents reviewed for supervision, who had a history of wandering into other residents' rooms and aggressive behaviors, resulting in R502 entering R501's room multiple times, attempting to get into her bed, and punching her in the face multiple times.

Inspectors wroteThis citation pertains to Intake Number(s): MI00142885, MI00142866, MI00142560, and MI00142461. Based on observation, interview, and record review, the facility failed to protect three (R810, R808, and R809) residents' rights to be free from physical and verbal abuse by staff and residents.

Inspectors wroteThis citation pertains to intake: MI00143440. Based on observation, interviews, and record reviews the facility failed to ensure the facility staff consistently identified worsening of pressure wounds, accurately assessed/identified pressure wounds, and timely/accurately implemented treatment for pressure wounds for one (R803) of one resident reviewed for wound care, resulting in an infection to the left heel wound that required intravenous (IV) antibiotics.

Inspectors wroteThis citation pertains to Intake# MI00142366 Based on observation, interview and record review the facility failed to ensure resident's medications were stored securely, administered as ordered and documented according to professional nursing standards for five (R802, R804, R812, R813 and R816) out of sixteen residents reviewed for professional standards.

Inspectors wroteThis citation pertains to Intake: MI00142560, MI00144323 Based on observation, interview and record review, the facility failed to administer a pre-procedural medication per physician orders for one resident (R813) resulting in termination of a diagnostic procedure.

Inspectors wroteThis citation pertains to intake: MI00143440. Based on observation, interviews, and record reviews the facility failed to ensure an accurate placement of a urinary catheter foley for one R803 of two residents reviewed for a urinary catheter.

Inspectors wroteThis citation pertains to Intake #MI00142366 Based on interview and record review the facility failed to ensure a resident received ordered pain medication in a timely manner for one (R812) out of one resident reviewed for pain, resulting in a significant increase in pain (10/10).

Inspectors wroteThis citation pertains to Intake #'s: MI00143426 and MI00144086. Based on observation, interview and record review the facility failed to ensure resident's received timely dental services, including denture replacement and tooth extractions for one (R802) out of three residents reviewed for dental care.

Inspectors wroteThis citation pertains to Intake: MI00144086. Based on observation, interview, and record review, the facility failed to perform hand hygiene consistent with accepted standards resulting in the potential for transmission of infectious material.

Inspectors wroteThis citation pertains to intake: MI00143743. Based on observation, interviews, and record reviews the facility failed to provide a written copy of the bed hold notification to the resident's representative, upon transfer to the hospital for one (R803) of four residents reviewed for transfers/discharges.

Inspectors wroteThis citation pertains to intake #MI00140379 and #MI00140532. Based on observation, interview, and record review the facility failed to ensure a patient assessment, a root cause analysis investigation, and timely clinical documentation of a fall for one resident (R902) of three residents reviewed for falls, resulting in the potential for undetected injuries and future incidences of falls.

Inspectors wroteBased on interview and record review, the facility failed to ensure physician visits/assessments were completed and/or documented timely for one (R81) of two residents reviewed for physician visits, resulting in delayed practitioner assessments, and the increased potential for lack of coordination of care.

Inspectors wroteBased on interview and record review, the facility failed to ensure physician evaluations were alternated between the physician and extenders (Nurse Practitioner/NP) as required for one (R81) of two residents reviewed for physician visits.

Inspectors wroteThis citation pertains to Intake MI00137216 Based on observation, interview, and record review, the facility failed to ensure accurate, complete, and timely documented medical records for five residents (R#'s 336, 440, 636, 438, and 96) of five residents reviewed for accurate, complete, and timely documented records, resulting in Health Insurance Portability and Accountability Act (HIPAA) violations of privacy and the potential for additional privacy violations.

Inspectors wroteBased on interview and record review the facility failed to ensure that two (R4 and R110) residents received a clear understanding of the facility's Binding Arbitration agreement prior to signing the document and ensure that facility staff had a clear understanding of the legal document.

Inspectors wroteBased on interview and record review, the facility failed to establish an antibiotic stewardship program that failed to establish an antibiotic stewardship program that included consistent implementation of protocols for appropriate antibiotic use. This deficient practice affected multiple residents (including R42, and R637) at the facility.

Inspectors wroteThis citation pertains to intake #'s MI00138955 and MI00137521. Based on observation, interview and record review the facility failed to honor preferences for the provision of caregivers for one resident (R101) of one residents reviewed for self-determination.

Inspectors wroteThis citation pertains to intake #MI00139363 Based on observation, interview and record review, the facility failed to ensure timely revision/updates to the comprehensive plan of care for one resident (R29) of one resident reviewed for wandering/elopement.

Inspectors wroteThis citation contains two deficient practice statements DPS1 Based on observation, interview and record review the facility failed to ensure one resident (R34) was administered Lactulose, Nasal Spray and two as need(PRN) medications as requested according to professional standards of practice.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure wrist and hand orthotics were applied per therapy recommendations for one resident (R25) with contractures of six residents reviewed for range of motion and orthotics, resulting in the potential for worsening of contractures.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure Physician orders for oxygen therapy were in place for one resident (R118) of two residents reviewed for respiratory care.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide justification for the increase of an antipsychotic medication(Quetiapine/Seroquel) including identified targeted behaviors for one (R105) of five residents reviewed for unnecessary medications.

Inspectors wroteThis citation pertains to intake #MI00139363 Based on observation, interview and record review, the facility failed to provide timely laboratory services to two (R29 and R81) of two residents reviewed for laboratory services.