Boulder Park Terrace
Boulder Park Terrace in Charlevoix, MI — inspection on August 14, 2025.
Found 3 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
(injury/decline/room, etc.) that affect the resident.
had the potential for requiring physician intervention for one Resident (R1) of three residents
resident's rights.
Findings include:This intake pertains to 2586236, 2583430Resident R1Review of R1's Electronic Medical Record (EMR) revealed admission to the facility on 7/25/25 with diagnosis including fracture of right humerus and neoplasm of the breast, brain and bone. R1's ?admission Paperwork' including R1's ?Health Care Decision/Code Status' was not completed until 7/28/25.Review of R1's Progress Notes revealed the following entries: 07/25/2025 1:17PM Report received from [Hospital Name] approx. (approximately) 1:15: resident arrived at the hospital on 7/22/25 from [Assisted Living Name] with a right humorous fx (fracture) that family declined to have repaired.Family has dentures and cell phone. she is here for rehab to strengthen her legs as she has had several falls. 07/26/2025 7:02PM This writer was called to resident's room at 4:00PM. CNA (Certified Nurse Aide) informed me that resident was sitting in her wheelchair and lifted her left arm to reach for the bed mobility bar to begin a transfer.
Resident heard a pop and reported she could no longer move left extremity.
Upon observation, it was visibly misaligned. EMS was called at 6:05 PM, arrived at 6:10 PM.Prior to departure, transfer form/bed hold policy was given to resident.
Resident's emergency contact in her chart does not have a phone number listed. DON notified 6:50 PM, On-call provider notified at 7:02 PM. 07/27/2025 4:38AM Resident returned to facility 8:15pm.
She has a fracture to L (left) humerus and returned with L arm in a sling as well.
States she is in pain . 7/28/25 6:34 PM (written by Physician A) .EMERGENCY CONTACTS PRESENT (Emergency Contact B) Consenting individual that in the event of an emergency, they would like for the following individuals to make medical decisions for them.
They also state that this person is aware of their advanced directives and wishes for any typeof medical decisions that need to be made.: YES 07/29/2025 3:58PM Resident is alert and oriented x4.Up in wheelchair with daughter visiting. 07/29/2025 9:05PM Called to resident room.
Upon entering, observed resident on her R (right) side on the floor, no grippy socks and did not activate call light for assistance 07/29/2025 11:29PM Resident now states she is in great pain & thinks she broke her R elbow and is requesting to go to the ER.Ambulance departed with resident at 11:35 PM. resident was given bed hold policy and transfer form.A phone interview was conducted with Emergency Contact B on 8/13/25 at approximately 3:30 p.m. who stated that he was never informed of R1's transfers to the hospital on 7/26/25 and 7/29/25.
Review of the facility's Admissions Policies read, in part, .The objectives of our admission policies are to:.reduce the fears and anxieties of the resident and family during the admission process' Review with the resident, and/or his/her representative (sponsor), the facility's policies and procedures relating to resident rights, resident care, financial obligations, visiting hours, etc.,; and assure that appropriate medical and financial records are provided to the facility prior to or upon the resident's admission.An interview was conducted with the Nursing Home Administrator (NHA) on 8/14/25 at approximately 2:00 p.m. who confirmed that the admissions policy was not being followed on the day of R1's admission into the facility and that staff should have gathered pertinent information such as Emergency Contact B's phone number prior to or on admission.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.
For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
235526 08/14/2025
Boulder Park Terrace 14676 West Upright Charlevoix, MI 49720
bed-hold policies.
interview and record review, the facility failed to form a recapitulation of stay for one Resident (R2)
R2Review of R2's Electronic Medical Record (EMR) revealed admission to the facility on 7/8/25 and discharge from the facility on 7/10/25 with diagnoses including restlessness and agitation, adult failure to thrive, and anorexia.Review of R2's Progress Notes revealed the following information: 07/10/2025 11:51AM Call to wife.She was not picking up her phone last night and staff unable to leave VMs to her.
She was very surprised on all that was replayed to her this am of the occurrences from last night.
Informed her that he was taken by the police in handcuffs to the ER because he not only assaulted staff but assaulted a police officer.
Relayed that he does not get along in a group setting, that he would not be able to continue staying here. We need to be able to actually care for him and he is refusing meds, refusing care, dumping his urinal, shouting the F word, assaulting staff.
She said we could bring him back to her house if we could transport him ourselves. We talked twice this am to communicate the plan.
Transporter taking back home now. We are unable to locate his glasses, but will check with the ER next door if he left them over there and attempt to get them back to her. He left with all other belongings, his W/C and rolled walker.There was no recapitulation of stay for R2 located in the EMR.An interview was conducted with the Nursing Home Administrator (NHA) on 8/14/25 at approximately 2:00 p.m.
The NHA confirmed that a recapitulation of stay was not completed for R2 prior to discharge on [DATE].
Review of the facility's Discharge Summary and Plan policy read, in part, When the facility anticipates a resident's discharge to a private residence, another nursing care facility (i.e., skilled, intermediate care, ICF/IID, etc.) a discharge summary and post-discharge plan will be developed which will assist the resident o adjust to his or her new living environment.the discharge summary will include a recapitulation of the resident's stay at this facility and a final summary of the resident's status at the time of the discharge
235526 08/14/2025
Boulder Park Terrace 14676 West Upright Charlevoix, MI 49720
prevent accidents.
fall for one Resident (R1) of three residents reviewed for falls.
Findings include:This intake pertains
to the facility on 7/25/25 with diagnosis including fracture of right humerus and neoplasm of the breast, brain and bone.Review of R1's Progress Notes revealed the following entries: 07/29/2025 9:05PM Called to resident room.
Upon entering, observed resident on her R (right) side on the floor, no grippy socks and did not activate call light for assistance 07/29/2025 11:29PM Resident now states she is in great pain & thinks she broke her R elbow and is requesting to go to the ER.Ambulance departed with resident at 11:35 PM. resident was given bed hold policy and transfer form.Review of R1's Care Plans revealed the following: Problem Start Date: 7/25/25; At risk for falls related to R (right) humorous fracture.Approach:.Ensure resident has grippy socks or footwear with grippy soles for safe ambulation and transfers; created 7/25/25.An interview was conducted with the Nursing Home Administrator (NHA) on 8/14/25 at approximately 2:00 p.m.
The NHA confirmed that R1 should have been wearing the proper foot interventions on 7/29/29.
Review of the facility's Falls-Clinical Protocol policy read, in part, .Based on the proceeding assessment, the staff and physician will identify pertinent interventions to try to prevent subsequent falls and to address the risks of clinical significant consequences of falling.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.