Regency at Troy

Inspectors wroteThis citation pertains to intake 3069088. Based on interview and record review, the facility failed to ensure a dental evaluation was completed in a timely manner for one resident (R901) of two residents reviewed for Nutrition, resulting in continued oral pain, facial swelling, delay in starting speech/language pathology therapy (SLP) and subsequently being kept on a pureed diet.

Inspectors wroteThis citation pertains to intake #3074446. Based on interview and record review, the facility failed to address concerns/grievances for one resident (R108) of one resident reviewed for grievances, resulting in verbalized frustration and lack of resolution for concerns/grievances.

Inspectors wroteThis citation pertains to intake #2963192. Based on observation, interview and record review the facility failed to prevent a fall for one Resident (R121) and failed to assess and provide interventions to prevent choking for one Resident (R79) out of seven residents reviewed for falls/accidents, resulting in R121 sustaining a fracture to the right femur, pain and extended hospital stay.

Inspectors wroteBased on interviews and record reviews the facility failed to maintain an ongoing Infection Control Program, ensure consistent and accurate surveillance of the facility's infections and failed to consistently implement the facility's Infection Prevention Program policy, this had the ability to affect all residents' that resided in the facility, including R31.

Inspectors wroteBased on interview and record reviews the facility failed to ensure ongoing oversight of the appropriateness of antibiotics and failed to ensure the criteria for infections were met, this had the ability to affect multiple residents that resided in the facility that was prescribed antibiotics.

Inspectors wroteThis citation pertains to intake 2987034. Based on interview and record review, the facility failed to ensure interdisciplinary care plan reviews were completed with the resident and/or legal representative, included the required interdisciplinary team (IDT) members, and were done in accordance with each Minimum Data Set (MDS) assessment for two (R43 and R120) of three residents reviewed for care plan review, resulting in the lack of opportunity for the resident and/or legal representative to participate in discussion of treatment options and decisions which pertain to all aspects of their plan of care.

Inspectors wroteThis citation pertains to intake 3030553 Based on observations, interviews, and record reviews the facility failed to develop, implement, and monitor an effective restorative nursing program for two (R26 & R27) of three residents identified as having the potential to maintain or improve their functional abilities. The facility did not consistently assess residents for restorative nursing needs, establish individualized restorative goals, or ensure restorative interventions were provided as planned.

Inspectors wroteThis citation pertains to Complaint #3014976Based on interview and record review the facility failed to ensure a resident received necessary physician ordered medication upon admission for one (R129) out of one resident reviewed for significant medication errors.

Inspectors wroteThis citation pertains to Intake(s): 2795651, 2796703, 2786658, 2725790, 2634630 Based on observation, interview and record review the facility failed to ensure a resident at risk for pressure ulcers was timely assessed and timely treated for pressure ulcers for one (R706) of five residents reviewed for pressure ulcer/wound care resulting in R706 obtaining a facility acquired stage 4 pressure ulcer that required hospitalization and surgery and pain.

Inspectors wroteThis citation relates to Intake 2702800, 2746398, 2800213, 2651998, 2646662, 2634630, 2795651, 2796703, 2649843, 2785783, and 2749201. Based on observation, interview, and record review, the facility failed to ensure adequate provision of activities of daily living care including incontinence care for four Residents (R703, R708, R709, and R715) of ten residents reviewed for activities of daily living and incontinence care.

Inspectors wroteThis citation pertains to intake: 2634630. Based on interview and record reviews the facility failed to report an allegation of mistreatment to the State Agency (SA) and failed to follow the facility policy for one (R716) of three residents reviewed for abuse.

Inspectors wroteThis citation pertains to intakes: 2795651 & 2796703. Based on interview and record reviews the facility failed to ensure acceptable standards of Nursing care and services was provided for one (R704) of two residents reviewed for a change in condition.

Inspectors wroteThis citation pertains to Intake #2785783 and 2634630. Based on observation, interview and record review the facility failed to provide timely assistance with feeding for two residents who required feeding assistance (R702 and R718) out of four residents reviewed for food concerns.

Inspectors wroteThis citation pertains to Intake #2634630 Based on observation, interview and record review the facility failed to ensure wound care was administered both timely and correctly for one (R719) of five residents reviewed for wound care.

Inspectors wroteThis complaint pertains to Intake #2702800. Based on observation, interview and record review the facility failed to ensure a resident with a history of Urinary Tract Infections (UTI) received timely urine samples causing a delay in treatment and extended pain for one (R702) out of three residents reviewed for UTI's.

Inspectors wroteThis citation pertains to intakes: 2795651 & 2796703. Based on interview and record reviews the facility failed to ensure oxygen therapy and maintenance was administered as ordered by the Clinician for one (R704) of one resident reviewed for respiratory care.

Inspectors wroteThis citation pertains to intake: 2709710. Based on interview and record reviews the facility failed to implement adequate/effective fall interventions and ensure consistent follow up of fall interventions implemented, for one (R201) of one resident reviewed for falls. This resulted in a transfer to the hospital and the identification of a left ischium fracture.

Inspectors wroteThis citation pertains to intake: 2709710. Based on interviews and record reviews the facility failed to ensure non-pharmacological interventions were consistently utilized before the administration of pharmacological interventions, failed to ensure appropriate indication for psychotropic medications, failed to revise and individualized the behavioral health care plan, and ensure behavioral health service monitoring for one (R201) of one resident reviewed for falls.

Inspectors wroteThis citation pertains to intake: 2605657. Based on interview and record reviews the facility failed to ensure an appropriate admission, staff competency and ensure coordinated care was implemented prior to the admission of one (R708) of four residents reviewed for quality of care.

Inspectors wroteThis citation pertains to intake: 2605657. Based on observation, interview and record reviews the facility failed to ensure bladder incontinence care was completed timely for one (R702) of three residents reviewed for a urinary tract infection.

Inspectors wroteThis citation pertains to intake #2605657Based on observation, interview and record review, the facility failed to ensure medications were stored appropriately in one medication cart of one medication carts reviewed for medication storage and labeling.

Inspectors wroteThis citation pertains to intake #'s 2605657 and 2623220. Based on observation, interview and record review, the facility failed to ensure a substantial evening meal was provided for one resident (R709) of three residents reviewed for meals/food.

Inspectors wroteThis citation pertains to intake # 2605657. Based on observation, interview and record review, the facility failed to ensure infection control procedures were followed for one resident (R709) of three residents reviewed for infection control.

Inspectors wroteThis complaint pertains to complaint 2587774Based on interview and record review facility failed to ensure timely admission orders were implemented for one (R901) of two residents reviewed for admission orders resulting in the potential for residents to not receive timely care/services with potential for decline in their health condition and avoidable hospitalization.

Inspectors wroteThis complaint pertains to complaint 2587774 and 1361575. Based on observation, interview, and record review facility failed to ensure nursing professional standards were consistently followed for two (R907 and R910) of two residents reviewed for nursing standards, when staff failed to reconcile the medication orders for R907 for an extended period; and failed to administer timely as ordered and document medication administration for R910. This deficient practice has the potential for adverse effect/interaction from improper dose/time and overall decline in health condition with/without avoidable hospitalization.

Inspectors wroteThis intake pertains to intake # 2587857. Based on observation, interview, and record reviews, the facility failed to properly label, and date opened insulin pens for two of two residents (R911 and R912) reviewed for medication storage, resulting in insulin pens being mixed up and the potential to administer the incorrect insulin to a resident and adverse reactions.

Inspectors wroteThis citation pertains to Intake MI00152492 Based on observation, interview and record review the facility failed to accurately assess, monitor, and document, catheter care for three residents (902, 904, 905) of three reviewed for catheter use. Additionally, the facility failed to document Urology Consultations, and evaluate the long term administration for Pyridium (analgesic medication used to relieve urinary tract discomfort, including pain, burning, and urgency) resulting in the delay of diagnosing and treatment of a Urinary Tract Infection (UTI), Sepsis (an infection causing injury to its own organs) and hospitalization and subsequently death.

Inspectors wroteThis citation pertains to Intake(s) #: MI00151883 and MI00153034. Based on observation, interview and record review the facility failed to maintain complete and accurate electronic medical records for two (R904 and R906) out of six residents reviewed for medical records. Complaints were filed with the State Agency (SA) that alleged residents were not receiving Activities of Daily Living (ADL)/Shower Care on a regular basis and not receiving medication timely. R904 On 5/13/25 at approximately 12:08 PM, R904 was observed sitting in a wheelchair. Their hair appeared greasy, and they had long nails. The resident was alert and able to answer most questions asked. When asked if they received ADL care including nail and shower/bath care, R904 reported that they have not received a shower since being admitted to the facility at the end of April 2025. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to prepare food in accordance with professional standards for food service safety. This deficient practice has the potential to result in food borne illness among all residents that consume food from the kitchen.

Inspectors wroteThis citation pertains to intake # MI00150969 Based on observation, interview and record review, the facility failed to treat residents with dignity and respect for three (R60, R52 and R318) of four resident reviewed for dignity.

Inspectors wroteBased on interview and record review, the facility failed to ensure that grievances/concerns were promptly documented, investigated, tracked and resolved for two residents (R7 and R60) of six residents that participate in the resident council (RC) meetings.

Inspectors wroteThis citation pertains to Intake #MI00151101, MI00150969 Based on observation, interview, and record review, the facility failed to ensure staff provided prompt response to answering call light requests for four (R7, R60, R17, R37) of four reviewed for Activities of Daily Living resulting in R7 left in a soiled brief for an extended period on 3/25/25 leading to concern of developing an infection. Findings Include: Clinical record review revealed R7 was admitted to the facility on [DATE] with a history of stroke resulting in impaired mobility with right sided weakness, COPD (Chronic Obstructive Pulmonary Disease) and diabetes. R7 was identified as incontinent of bladder and bowel and had a history of Urinary Tract Infections (UTI's). Brief Interview of Mental Status (BIMS) dated 1/18/25 revealed R7 scored 14/15 indicating no cognitive impairment. [...]

Inspectors wroteThis citation pertains to intake #MI00151325 Based on observation, interview, and record review, the facility failed to implement appropriate interventions timely and consistently as recommended/indicated for two (R48 and R38) of four residents reviewed for accidents resulting in the potential for further falls, elopements, and avoidable accidents.

Inspectors wroteBased on observation, interview, and record review facility failed perform appropriate hand hygiene during medication administration (R80, R35, R59), and wear appropriate Personal Protective Equipment (PPE) while providing service/care to resident(s) (R45, and R365) who were on contact precautions and enhanced barrier precautions respectively, for five of five residents reviewed for infection prevention/control practices resulting in the potential for cross-contamination with likelihood for spread of infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to accommodate a resident with the appropriate bed for one Resident (R92) of two residents reviewed for accommodation of needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure Nursing standards of practice were followed for medication administration for one resident (R7) of one residents reviewed for pain management.

Inspectors wroteBased on observation, interview, and record review, the facility failed to transcribe and implement treatment orders as prescribed by the Physician for one resident (R18) reviewed of one resident reviewed for edema.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide adequate standards of care including lack of proper positioning and adequate documentation for two Residents (R81 and R312) of two residents reviewed for pressure ulcers.

Inspectors wroteThis citation pertains to intake: MI00150969 Based on interview and record review facility failed to implement appropriate and consistent weight monitoring for one (R360) of six residents reviewed for nutrition resulting in the potential for unidentified weight loss and malnutrition with overall decline.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide comprehensive behavioral care management for one Resident (R12) of one resident reviewed for behavior health services.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medications, including medications used for treatments, were appropriately stored and in a safe manner for four residents (R45, R46, R81 and R7) of four residents reviewed for safe storage.

Inspectors wroteBased on interview and record review the facility failed to ensure a laboratory diagnostic (lab) was completed in a timely manner per the Physician's order for one resident (R13) of one residents reviewed for laboratory diagnostics.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide alternate menus and alternate meal choices for one Resident (R312) of one resident reviewed for menus.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an attractive palatable pureed meal to one resident (R45) of one resident reviewed for meal service, resulting in verbalized complaints and dissatisfaction with meal service and potential for weight loss.

Inspectors wroteThis citation pertains to intake #MI00150135. Based on interview and record review the facility failed to provide scheduled showers for one resident (R702) of three residents reviewed for activities of daily living, resulting in verbalized complaints and frustration with the provision of care.

Inspectors wroteThis citation pertains to intake #MI00149847 Based on observation, interview, and record review, the facility failed to ensure physician ordered dressing changes for pressure ulcers were performed for one resident (R701) of three residents reviewed for pressure ulcers, resulting in the potential for worsening of wounds and development of infections.

Inspectors wroteThis citation pertains to intake #MI00149847. Based on observation, interview, and record review, the facility failed to ensure appropriate transmission based precautions were implemented for one resident, (R701) of three residents revealed for infections, resulting in the potential for the development of infection.

Inspectors wroteThis citation pertains to Intake #MI00149338. Based on observation, interview and record review facility failed to document and promptly resolve grievances/concerns reported to facility staff for one resident (R901) of three residents reviewed for grievances.

Inspectors wroteThis citation pertains to intake: MI00148683. Based on observation, interview and record reviews the facility failed to ensure the kitchen staff followed proper procedures for sanitation and food storage, this had the ability to affect all 78 of 78 residents that resided in the facility at the time of the survey.

Inspectors wroteThis citation pertains to intake: MI00148683. Based on interview and record reviews the facility failed to timely identify, intervene, and notify the physician of a change in respiratory condition for one (R901) of three residents reviewed for a change of condition, resulting in the delayed care, delayed notification to the physician/practitioner and ultimately requiring a transfer to the hospital for a higher level of care.

Inspectors wroteThis citation pertains to intake: MI00148683. Based on interview and record reviews the facility failed to consistently implement and apply wound treatments as ordered by the practitioner timely, failed to consistently identify and report worsening of the wound to the Wound Practitioner (WP) and failed to document clinical reasons and/or justification for the change of an antibiotic treatment, and the delayed/missed IV (Intravenous) and oral antibiotics for a wound infection, for one (R901) of three residents reviewed for wounds, resulting in delayed and omitted treatments and transfers to the hospital for higher level of care.

Inspectors wroteThis citation pertains to intake: MI00148683. Based on interview and record review the facility staff failed to ensure all required documentation for a transfer to the hospital was documented in the medical record for one (R901) of three residents reviewed for a change of condition.