Riverview Health & Rehab Center

Inspectors wroteThis citation pertains to intakes MI00153605 and MI00153653. Based on interview and record review, the facility failed to report facial bruising and posterior nasal fracture of unknown origin for one (R702) of four residents reviewed for abuse, resulting in an unreported incident of potential abuse.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow the standards of practice for administering medications through a Gastrostomy/PEG tube (a flexible tube surgically inserted directly into the stomach through the skin of the abdomen to deliver nutrition, hydration, and medication) for two (R51 and R129) of four residents reviewed for medication administration resulting in residents not receiving the full amount of their prescribed medications and the potential for PEG tube malfunction due to clogging.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide timely and appropriate care to a supra-pubic (s/p) catheter (flexible tube surgically inserted into the bladder through the skin of the abdominal wall) for one (R97) of one resident reviewed for catheter care resulting in delayed assessment and treatment of R97's s/p catheter.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain sanitary conditions in the kitchen resulting in an increased potential for cross contamination of food and foodborne illness, potentially affecting the facility's total census of 138 residents who receive meal services.

Inspectors wroteBased on observation, interview, and record review the facility failed to maintain an effective pest control program to ensure that the facility is free of pests, resulting in an increased potential for contamination of food, both food and non-food contact surfaces, and foodborne illness potentially affecting staff, visitors and all 138 residents.

Inspectors wroteBased on observation and interview the facility failed to provide a safe, functional, and sanitary environment for the facilities census of 138 residents and its staff resulting in an increased potential for harm.

Inspectors wroteBased on interview and record review, the facility failed to ensure one (R70) of four residents reviewed for advance medical directives (AMD) had their code status/treatment preferences documented in their Electronic Health Record (EHR).

Inspectors wroteBased on interview and record review, the facility failed to ensure the Preadmission Screening (PAS)/ Annual Resident Review (ARR) form for Mental Illness/ Intellectual Disability/ Related Conditions Identification (DCH-3877) document was accurate, complete, and sent to the local state agency for an evaluation for a Level II determination for one (R70) of three residents reviewed for PASSARs, resulting in the potential for unmet intellectual/ developmental disability care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to consistently implement interventions (a low-air-loss specialty mattress) for one (R114) of thirteen residents reviewed for pressure ulcer care resulting in the potential for continued impaired skin integrity.

Inspectors wroteThis citation pertains to intake MI00140641 and MI00139226. Based on observation, interview, and record review, the facility failed to provide adequate ADL (Activities of Daily Living) care for one resident (R41) of six residents reviewed for ADLs, resulting in debris-filled and odorous feet. Findings Include: On 5/14/2024 at 2:40 p.m., R41 was observed lying in bed alert unable to be interviewed. R41's feet were observed with yellowish thick dry debris between all toes with an odor. Unit Manager/Licensed Practical Nurse UM/LPN D agreed R41's feet had an unpleasant odor. UM/LPN D said it shouldn't have been that much of debris between the resident's toes especially if routine showers was completed. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to effectively clean and maintain the physical plant effecting 131 residents, resulting in the increased likelihood for cross-contamination, bacterial harborage, decreased illumination, and reduced indoor air quality.

Inspectors wroteR35 On 2/27/23 at 3:05 PM R35 was observed seated in his wheelchair in his room. R35's urinary catheter was tucked down through his pant legs and into a drainage bag that had a privacy cover. R35 said his catheter gets in the way and he has had problems with his catheter being pulled and tugged on that causes him pain. On 3/01/23 at 9:51 AM R35 was observed laying in his bed with his urinary catheter tubing draining into a collection bag attached to the bed frame. The urinary catheter was not attached to an anchoring device. At this time CNA P was asked about the catheter being anchored to the resident's thigh. CNA P said, Yes, the catheter should be attached to his thigh with tape or something. I'll get one from the nurse. On 3/02/23 at 10:25 AM R35 was observed laying in his bed with his urinary catheter tubing draining into a collection bag attached to the bed frame. [...]

Inspectors wroteR88 During interview on 2/27/2023, at 11:25 AM, when ask about the food menu's, R88 said, I do not know what is being served. I do not get a menu and I do not get to make any choices. Record review revealed R88 was admitted on [DATE], with diagnosis that included heart failure and hypertension. R88 was alert and oriented and cognitively intact. R38 During an interview on 2/28/2023, at 10:12 AM, R38 said she did not like the food and did not know what was ever going to be served for her meals. When R38 was queried did she get a choice of selecting foods items from the menu, R38 shook her head indicating no. Record Review revealed R38 was admitted on [DATE], with diagnosis: seizures, hypertension, diabetes mellitus. R38 was, alert, oriented and able to make needs known. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to effectively clean and maintain food service equipment effecting 88 residents, resulting in the increased likelihood for cross-contamination, bacterial harborage, and decreased illumination.

Inspectors wroteBased on interview and record review the facility failed to offer immunizations and provide education for five residents (R29, R43, R104, R115, and R124) of five residents reviewed for immunizations, resulting in the potential for the spread of respiratory infection among respiratory compromised residents. Findings Include: R29 Record review revealed R29 was admitted into the facility on [DATE] and readmitted on [DATE] with a pertinent diagnosis of chronic (long term) respiratory failure. According to the Minimum Data Set (MDS) dated [DATE], R29 had Impaired cognition and was required total assistance with Activities of Daily Living (ADLS) Record review of R29's Preventative Health Care revealed no documentation that immunizations for influenza, pneumococcal were offered or education provided. There was no documentation of the refusal of immunizations. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide care in a respectful and dignified manner for two (R17 and R79) of seven residents reviewed for resident rights resulting in R17 and R79 being embarrassed and having feeling of low self-esteem when nursing staff talked on their cell phones about after-work activities while delivering care to the residents.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement care plan interventions effecting three residents (R127, R58, and R65) of 34 residents reviewed for comprehensive care plans, resulting in the potential for unmet needs. Findings Include: R127 During observation on 2/27/23 at 9:53 AM in R127's room, resident was seen to have an indwelling urinary catheter (device used to empty the bladder of urine). Record review of R127's face sheet revealed admission into the facility on 1/14/23 and readmission on [DATE] with a pertinent diagnoses of a stage four pressure ulcer (Bedsore with muscles and tendons exposed). According to the MDS dated [DATE], R127 had impaired cognition and was total dependence with ADL care. Further review of section H (bowel and bladder) marked R127 had an indwelling catheter. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure orthotic devices (hand/arm splints) were provided for two (R65 and R110) of 10 residents reviewed for restorative services resulting in the potential for deconditioning and worsening of contractures.

Inspectors wroteThis citation pertains to intake MI00130258. Based on observation, interview, and record review the facility failed to follow the standards of infection control for proper PPE use (mask, gloves, gown) and hand hygiene for one resident (R43) out of three residents reviewed for transmission based precautions, resulting in the increased potential for cross-contamination of diseases which places a vulnerable population at high risk for infections.