Wellbridge of Rochester Hills

Inspectors wroteThis citation pertains to intake: 3017844. Based on observation, interviews and record reviews the facility failed to complete a thorough investigation for an injury of unknown origin for one (R204) of three residents reviewed for an injury of unknown origin. R204 was diagnosed with a right leg . comminuted impacted proximal tibial shaft fractures, mild posterior displacement of the distal fracture fragment, minimal angulation. Comminuted proximal fibular shaft fractures (both lower right leg bones broken, the tibia and fibula fractured in multiple pieces and the broken bone pieces pushed into each other from the force of the injury) .

Inspectors wroteThis citation pertains to intake #3015838. Based on interview and record review, the facility failed to assess and implement interventions/diagnostics in a timely manner for one resident (R202) of three residents reviewed for changes in condition.

Inspectors wroteThis citation pertains to intake: 2711407. Based on interview and record review the facility failed to ensure a Physician evaluation and/or assessment of wounds and failed to follow the facility's policy for Pressure Ulcers for one (R205) of three residents reviewed for wounds.

Inspectors wroteThis citation pertains to intake(s): 2706041 & 2711391. Based on observation, interview, and record reviews the facility failed to protect the resident's right to be free from misappropriation by a facility staff member, for one (R203) of three residents reviewed for misappropriation and abuse.

Inspectors wroteThis citation pertains to intake(s): 2706041 & 2711391. Based on observation, interview and record reviews the facility failed to implement policies and procedures for ensuring the reporting of a reasonable suspicion of a crime in accordance with section 1150B of the Act and failed to accurately and timely report findings to the State Agency (SA) for one (R203) of three residents reviewed for Misappropriation and Abuse.

Inspectors wroteThis citation pertains to Intake 2677719Based on interview and record review, the facility failed to protect the residents' right to be free from neglect for 14 residents (R's 3, 5, 7, 25, 26, 39, 66, 70, 72, 88, 97, 103, 104 and 108) of 19 residents reviewed for neglect.

Inspectors wroteBased on observation, interview and record review the facility failed to provide information regarding an advance directive & failed to offer the resident and/or resident representative the opportunity to formulate an advance directive for one (R56) of one resident reviewed for advance directives.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide adequate positioning to prevent the potential for wound development and progression for one Resident (R108) of two residents reviewed for positioning.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident received assistance with their hearing aides to maintain their hearing ability for one (R89) of one resident reviewed for hearing.

Inspectors wroteThis citation relates to Intakes 2614504 and 2569835. This citation has two Deficient Practice Statements (DPS). DPS #1 Based on observation, interview, and record review, the facility failed to prevent an avoidable accident when one resident, R901, of two residents reviewed for supervision fell out of bed during care.

Inspectors wroteThis citation pertains to Intake Number(s): MI00152206. Based on observation, interview, and record review, the facility failed to provide care according to the preference of the resident's legal decision maker for one (R901) of two residents reviewed for care planning and activities of daily living.

Inspectors wroteThis citation pertains to Intake Number(s): MI00153363. Based on interview and record review, the facility failed to treat the resident's high blood sugar in a timely manner for one (R902) of one resident reviewed for diabetes management.

Inspectors wroteThis citation pertains to Intake #: MI00150503. Based on observation, interview, and record review facility failed to investigate an incident of hot liquid spill (unknown resident) and failed to implement interventions/supervision related to falls for two (R801 and R803) of four residents reviewed for accidents resulting in a fall with major injury and hospitalization (R803); with potential for continued falls for R803.

Inspectors wroteThis Citation pertains to intake MI00148469 Based on [observations/interviews/record review], the facility failed to protect the resident ' s (R402) right to be free from mental and physical abuse by staff (CNA B).

Inspectors wroteBased on observation, interview, and record review, the facility failed to safely assist with a transfer to the toilet, wheelchair, and bed, complete a thorough and timely investigation to determine the root cause of injuries and accidents, and implement effective interventions to prevent multiple falls for four (R9, R8, R25, and R35) of seven residents reviewed for accidents, resulting in R9 falling during a transfer to the toilet and sustaining a tibia fracture that required surgery, R25 sustaining a hematoma that required treatment in the hospital after being injured during a mechanical lift transfer and two additional hospitalizations regarding hoyer lift injuries, and R35 sustaining abrasions to the legs and face after falling.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure nursing staff correctly provided residents with their physician ordered medications for three (R25, R30 and R45) out of three residents reviewed for professional standards.

Inspectors wroteBased on observation, interview, and record review, the facility failed to identify and treat new venous ulcers, ensure physician oversight, and accurately assess a change in skin condition for two (R21 and R12) of three residents reviewed for non-pressure skin conditions.

Inspectors wroteThis citation pertains to Intake MI00145482 Based on interview and record review, the facility failed to ensure controlled substances were stored in locked compartments in the 400-Hall. This deficiency had to ability to affect all residents with prescribed controlled substances residing on the 400-Hall.

Inspectors wroteThis citation pertains to Intake MI00145482 Based on interview and record review the facility failed to prevent misappropriation of a controlled substance medication for one (R401) of three residents reviewed for misappropriation of resident property.

Inspectors wroteThis citation pertains to Intake Number(s): MI00143710. Based on observation, interview, and record review, the facility failed to identify and treat a wrist fracture in a timely manner for one (R701) of three residents reviewed for changes in condition.

Inspectors wroteThis citation pertains to Intake MI00143662 Based on interview and record review, the facility failed to ensure a physician and/or physician extender evaluated and assessed pressure ulcers for one (R702) of three residents reviewed for pressure ulcers.

Inspectors wroteThis citation pertains to intake #'s MI00140124 and MI00141728. Based on interview and record review the facility failed to ensure medications were administered per physician's orders for one resident (R802) of three residents reviewed for medication administration, resulting in verbalized complaints and feelings of frustration.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure appropriate interventions and treatments were in place to prevent the development/worsening of a heel ulcer for one resident (R38) of three residents reviewed for pressure ulcers, resulting in R38 obtaining a stage 3 pressure ulcer on their right heel.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure four (R8, R24, R61, and R290) of four residents reviewed for medications were assessed for the safe self-administration of medication and to have medication kept at bedside.

Inspectors wroteBased on observation, interview and record review the facility failed to provide necessary medical equipment and water needed to ensure residents care needs were met for two (R45 and R66) out of four residents reviewed for accommodation of needs/choices .

Inspectors wroteBased on interview and record review the facility failed to timely remove Certified Nursing Assistant (CNA) K from the facility after it was alleged, they physically abused one resident (R190) out of two residents reviewed for abuse. This deficient practice had the ability to affect all resident's receiving care from CNA K.

Inspectors wroteBased on interview and record review, the facility failed to notify, in writing the reason for a discharge out of the facility to a representative of the State Long term Care Ombudsman for one (R86) of three residents reviewed for discharges. This deficient practice has the potential to affect all residents that discharged from the facility.

Inspectors wroteBased on observation, interview and record reviews, the facility failed to ensure a level I Preadmission Screening (PAS)/Annual Resident Review (ARR) Mental Illness/Intellectual Disability/Related Conditions Identification was completed and sent to the local community mental health for a level II OBRA (Omnibus Budget Reconciliation Act of 1993) evaluation for one (R78) of one resident reviewed for PASARRs. This deficient practice resulted in the potential for the resident to be excluded from receiving necessary care and services appropriate to meet their mental health and intellectual disability needs.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure accepted Nursing standards were utilized for two residents (R24 and R291) of two residents reviewed for standards of practice which included providing supervision during Nebulizer administration and ensuring medications were reordered for uninterrupted administration.

Inspectors wroteBased on interview and record review the facility failed to ensure Physician orders were completed in a timely manner for two residents (R46 and R66) of two residents reviewed for quality of care.

Inspectors wroteBased on observation, interview, and record reviews the facility failed to implement adequate and individualized interventions to prevent further falls for two (R's 46 & 51) of three residents reviewed for falls.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure appropriate storage and labeling of medication in one of 14 hallway medication storage wall units.