Paradigm at Bay City

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 4 of 26 (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], and room [ROOM NUMBER]) resident rooms observed for environmental conditions. The facility failed to ensure rooms 150 bed A&B and 152 bed A&B had intact paint, no holes in drywall, and no dead bugs in shared restroom. The facility failed to ensure room [ROOM NUMBER] bed A&B had intact floor tiles. The facility failed to ensure room [ROOM NUMBER] bed A&B had running hot water in restroom sink. These failures could place residents at risk for diminished quality of life, discomfort, and safety.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that residents were free of a med error rate of 5% or greater for 1 of 4 (Resident #15) residents reviewed for medication administration. The facility failed to ensure the medication error rate of 26.67% (30 opportunities with 8 medication errors) was less than 5%. This failure placed residents at risk of incorrect doses of medications and optimal therapeutic response.

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, for 1 of 1 kitchen as evidence by: The facility failed to ensure:A. [NAME] C washed the food processor between use. B. Dietary Aide D and [NAME] E wore hair restraints properly covering all of their hair. C. The water machine used by the residents in the dining room was clean. These failures could place residents at risk for altered taste of food, foodborne illness and compromised health status and hair in food.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary services for residents who were unable to carry out activities of daily living to maintain good grooming and personal hygiene for 1 of 6 (Resident #14) reviewed for ADL care. The facility failed to ensure Resident #14's nails were trimmed, cleaned, and filed on 07/21/2026, and 07/22/2026. This failure could place residents at risk of loss of dignity, at risk of infection, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that a resident who needed respiratory care was provided such care, consistent with professional standards of practice for 1 (Resident #41) of 13 residents reviewed for quality of care. The facility failed to ensure oxygen use orders were obtained prior to Resident #41 receiving oxygen therapy. The facility failed to ensure Resident #41's nasal canula was discarded when discoloration or contamination was present on 07/21/2026, 07/22/2026, and 07/23/2026. The facility failed to properly store Resident #41's nasal canula when oxygen was not in use on 07/21/2026, 07/22/2026, and 07/23/2026. The facility failed to ensure there was an oxygen in use sign posted on Resident #41's room door. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary services to maintain grooming and personal care for 3 (Resident #32 Resident #19 and Resident #16) of 12 residents reviewed for ADL care, in that: - The facility failed to ensure Resident #32 was provided personal grooming (dry patches and flaky skin) by facility staff on 5/28/2025. - Resident #19 was not provided nail care. Resident #19's nails were long past the tips of his fingers with a dark substance on top and underneath his nail tips on 5/28/2025. - Resident #16 was not provided nail care. Resident #16's nails were long past the tips of her fingers with a dark substance underneath and dried substance on top the nails on 5/28/2025. This failure placed residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections, and a decreased quality of life.

Inspectors wroteBased on observation, interviews, and record reviews the facility failed to label drugs and biologicals used in the facility in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 1 medication storage rooms and 1 of 1 supply closets, reviewed for drug labeling and storage, in that: - The Medication Storage room had an inhaler that was open and in use, with no open date. It also had a TB vaccine vial and a Hepatitis B vaccine vial that was open with no opening date. - The Medication Supply closet had 4 expired bottles of liquid iron. These failures place residents at risk for receiving biologicals and medications which are ineffective and/or not safe.

Inspectors wroteBased on record review and interview, the facility failed to maintain medical records on each resident that are in accordance with accepted professional standards and practices and that are accurately documented for 2 (Residents #55 and #89) of 10 residents reviewed for medical chart documentation. -Resident #89's hospital records were not in her medical chart and was in Resident #55's medical chart. This failure could put residents at risk of privacy issues with their personal health information not being uploaded to the correct chart and health decisions made based off another resident's information.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 1 of 5 residents (Resident #30) reviewed for infection control, in that: - LVN A failed to wear PPE for EBP, when giving Resident #30 his g-tube (tube into stomach for nutrition) medications. This deficient practice could place residents at-risk for infection due to improper care practices.

Inspectors wroteBased on observation interview and record review, the facility failed to ensure that each resident had a right to secure and confidential personal and medical records for two (Resident #3 and Resident #4) of five residents reviewed for privacy. 1. RN A walked away and left Resident #3's personal information unattended and in display in the resident data portal. 2. Resident #4's MAR was left unlocked and unattended on a laptop at the nurses station. This failure could place 55 residents who's personal information is stored in the resident data portal at risk of personal information being exposed to unauthorized individuals. Findings Included: Record review of Resident #3's face sheet revealed a sixty-eight-year-old man who was initially admitted on [DATE]. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that each resident received adequate supervision and assistance devices to prevent accidents for 2 of 5 residents (Resident #1 and Resident #2) whose care was reviewed for accidents and supervision. 1. Resident #1 was smoking unsupervised and housed his cigarettes inside of his room. 2. Resident #2 was observed taking a cigarette out of his room before he went outside during the designated smoking hour. These deficient practices could affect residents at the facility who smoked by contributing to burns or serious injuries. Findings Included: 1. Record review of Resident #1's face sheet revealed a sixty-seven-year-old man was admitted to the facility on [DATE]. An admitting diagnosis was acute B chronic obstructive pulmonary disease (COPD, lung disease),. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 5 resident (Resident #24) reviewed for incontinent care. -The facility failed to ensure CNA JJ and CNA RR properly cleaned Resident #24 during incontinent care. This failure could place residents at risk for urinary tract infections (UTI), urethral erosions, discomfort, skin breakdown, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, and disposing of expired medications) to meet the needs of each of resident for 1 (resident #27) of 5 residents reviewed for gastrostomy (G-tube) medication administration in that: LVN A's cart contained an insulin Glargine injection pen100 units/ML prefilled expired 03/26/24, and LVN B's Enoxaparin 40mg/.4ml prefilled syringes expired on 03/27/24. LVN A's cart contained expired low control glucose control solutions. expired 12/23 and the high control expired 01/24. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals were secured properly for 1 of 5 medication carts reviewed for pharmacy services in that: The facility failed to ensure LVN A did not leave 1 optic medication on top of the medication cart unsupervised. This failure placed residents at risk for unauthorized access to the medication cart and consumption of harmful medications, misappropriation, and drug diversion.

Inspectors wroteBased on observation, interview and record review, the facility must dispose of garbage and refuse properly for 1 of 1 dumpster reviewed for garbage disposal. -The facility failed to ensure the dumpster lids and doors were secured. This failure could place residents at risk of infection from improperly disposed garbage.

Inspectors wroteBased on interviews, and record review the facility failed to ensure clinical records were maintained in accordance with accepted professional standards and practices, were complete, and accurately documented for 1 (Resident #13) of 5 residents reviewed for clinical records. LVN B failed to document Insulin administration on the eMAR on 03/04/24, 03/11/24, 03/15/24,03/19/24, 03/20/24 and 03/27/24. This failure could place residents at risk inappropriate and inadequate medication administration and a decline in health status.

Inspectors wroteBased on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infection for 1 of 4 residents (Resident #24) reviewed for infection. -The facility failed to ensure CNA JJ and CNA RR performed hand hygiene during incontinent care on Resident #24. This failure could lead to the spread of infection to residents, resident illness, and/or resident distress.

Inspectors wroteBased on observation, 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 timetables to meet a resident's medical and nursing needs for one (Resident #1) of four residents reviewed for care plans, in that: The facility failed to develop a care plan for Resident #1's foley catheter, recent severe dehydration and fecal impaction diagnoses, and his history of dehydration and constipation upon readmission to the facility after hospitalization. This failure could place residents at risk for not having their individual care needs met, errors in providing care, and poor/worsening condition. Findings Included: Record review of Resident #1's face sheet dated 01/11/24 revealed a [AGE] year-old male initially admitted to the facility on [DATE] and readmitted on [DATE]. [...]

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan for 1 of 4 residents (Resident #1) reviewed for quality of care. The facility failed to accurately modify interventions for Resident #1 when he was readmitted to the facility on [DATE] with a foley catheter, was recently hospitalized due to severe dehydration and fecal impaction, and a history of dehydration and constipation. These failures placed residents at risk for new development or worsening of existing infection, pain, and decreased quality of life.