Mission Point Nursing & Physical Rehabilitation Ce

F 0600 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Ativan (an anti-anxiety medication) but Resident R3 did not calm down for a good six and a half hours, he continued pacing and exit seeking. During an interview on 9/26/25 at 9:00 AM, CNA D reported that she was working

on the S2 unit on 9/13/25 at the time of the incident between Resident R3 and Resident R4. CNA D said that Resident R4 and 2 other residents really do not like other residents getting into their space. CNA D reported that she did not see Resident R3 enter Resident R4's room and thinks Resident R3 entered Resident R4's room through the adjoining bathroom. CNA D said the coffee was spilled on the floor in front of the bathroom and heard the cup hit the floor and heard Resident R4 yell that Resident R3 had hit him. CNA D said that Resident R4 didn't leave his room after the incident and Resident R3 continued to pace the halls and exit seek. CNA D said that she did not recall what interventions were put into place after the incident and reported staffing in the afternoons and evenings is tough because resident behaviors increase, and many residents need two people to assist with cares and are a high risk for falls, sometimes requiring what amounts to 1:1 supervision. CNA D said there used to be activities on the unit from 8:00 AM - 8:00 PM, but now it's like activities doesn't exist, and we (nursing staff) can't do it all. During an interview on 9/26/25 at 10:45 AM, RN F reported that she worked on the S2 unit the first shift on 9/13/2025 and reported Resident R4 was calm that day. RN F said that Resident R3 was going into and out of other resident rooms trying to get resident water cups. RN F reported there were no activities happening that day which makes things harder on nursing staff. Review of a facility policy Abuse, Neglect and Exploitation last reviewed/revised 10/2024 reflected It is

the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property. The policy includes Employee Training with topics that include 5. Understanding behavioral symptoms of residents that may increase the risk of abuse and neglect such as: a. Aggressive and/or catastrophic reactions of residents; b. wandering or elopement-type behaviors; c. resistance to care; d. Outbursts or yelling out; and e. Difficulty in adjusting to new routines or staff. Further review of the facility policy pertaining to Abuse, Neglect and Exploitation includes a discussion about Prevention - The facility will implement policies and procedures to prevent and prohibit all types of abuse, neglect, misappropriation of resident property and exploitation that achieves: . B. Identifying, correcting, and intervening in situations in which abuse, neglect, exploitation, and/or misappropriation or resident property is more likely to occur with the deployment of trained and qualified registered, licensed, and certified staff on each shift in sufficient numbers to meet the needs of the residents, and assure that

the staff assigned have knowledge of the individual residents' care needs and behavioral symptoms. D. The identification, ongoing assessment, care planning for appropriate interventions, and monitoring of residents with needs and behaviors which might lead to conflict or neglect.

Event ID:

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If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mission Point Nursing & Physical Rehabilitation Ce

414 E State Street Belding, MI 48809

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

CNA D reported that she was working on the S2 unit on 9/13/25 at the time of the incident between Resident R3 and Resident R4. CNA D reported she was not asked to provide a statement for the abuse investigation. During an

interview on 9/26/25 at 10:45 AM, RN F reported that she worked on the S2 unit the first shift on 9/13/2025.

A statement from RN F was not included in the investigation report. RN F reported there were no activities happening that day. Review of the facility policy Abuse, Neglect and Exploitation last reviewed/revised 10/2024 reflected A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur. The policy specified, .4.Idetifying and interviewing all involved persons, including the alleged victim, alleged perpetrator, witnesses, and others who might have knowledge of the allegations; 5. Focusing the investigation on determining if abuse, neglect, exploitation and/or mistreatment has occurred, the extent, and cause; and 6. Providing complete and thorough documentation of the investigation.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mission Point Nursing & Physical Rehabilitation Ce

414 E State Street Belding, MI 48809

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

activities will be designed to meet the interests of each resident, as well as support their physical, mental, and psychosocial well-being. Activities will encourage both independence and interaction with the community.5. Scheduled activities are posted in the resident's room, where appropriate, and in a prominent place in the facility.9. Special considerations will be made for developing meaningful activities for residents with dementia and/or special needs. These include, but are not limited to, considerations for: a. Residents who exhibit unusual amounts of energy or walking without purpose, b. Residents who engage in behaviors not conducive with a therapeutic home like environment, c. Residents who exhibit behaviors that require a less stimulating environment to discontinue behaviors not welcomed by others sharing their social space, d.

Residents who go through others' belongings.

Event ID:

Facility ID:

If continuation sheet