Hartford Nursing & Rehabilitation Center

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

with diagnoses that included congestive heart failure, chronic respiratory failure, diabetes mellitus type two, and chronic obstructive pulmonary disease. According to the quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] indicated Resident R156 was cognitively intact with a BIMS (brief interview for mental status) score of 15/15. Review of Resident R156 Nutritional/Hydration care plan revised on 11/29/2025 had the following: (Resident R156) has alteration in nutritional and/or hydration status related to diagnoses H, pylori (a stomach bacteria), hypertension, and morbid obesity.R62On 1/27/2026 at 1:30 p.m. Resident R62 was observed with no water cup in the room or at bedside. Resident R62 did not want to be interviewed.According to the electronic medical record (EMR), Resident R62 was admitted on [DATE REDACTED] with diagnoses that included ETOH, Left femur fracture, hypertension, history of falls, Carotid artery disease, and chronic obstructive pulmonary disease.

According to the quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] indicated Resident R62 was cognitively intact with a BIMS (brief interview for mental status) score of 15/15. Review of Resident R62 Nutritional/Hydration care plan revised on 1/22/2026 had the following: (Resident R62) has alteration in nutritional and/or hydration status related to diagnoses of adjustment disorder, BPH and schizophrenia.On 1/27/2026 at approx. 2:00 p.m. the unit's daily assignment was requested and provided. Review of the daily assignment revealed Certified Nursing assistant (CNA) T was Resident R62's Resident R76's, and Resident R18's assigned CNA for the dayshift (7:00 a.m. thru 3:00 p.m.).On 1/27/2026 at 3:00 p.m. CNA T was interviewed regarding providing water to the residents. CNA T acknowledged that water had not been passed but was going to pass water later. CNA T stated, the residents should have had water at the start of the shift at 7:00 a.m.On 1/27/2026 at 4:16 p.m. CNA U was the assigned CNA (was working an additional four hours) for residents Resident R156, and Resident R94. CNA U was asked was water passed for the shift. CNA U stated, I was really busy, but I am passing

the resident's water now. The residents should have received fresh water before now.On 1/29/2026 at 2:23 p.m. the Director of Nursing (DON) was interviewed regarding the appropriate time staff should pass water to residents. The DON was asked should the staff pass water before 3:00 p.m. and 4:00 p.m. for the shift.

The DON stated, Absolutely. The twelve-hours shift CNAs should pass water multiple times and the eight hours shift should pass fresh water before 3:00 p.m. and 5:00 p.m. usually by 10: 00 a.m. fresh water should be pass because midnight usually pass the resident fresh water before leaving their shift, but regardless fresh water should be pass before 3:00 p.m.According to the facility's 1/29/2026 Oral Hydration policy: It is

the policy of this facility to assist residents to maintain adequate hydration whenever possible. Procedure: 5.

Each resident will be provided bedside water.

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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

01/29/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hartford Nursing & Rehabilitation Center

6700 W Outer Dr Detroit, MI 48235

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 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Level of Harm - Minimal harm or potential for actual harm

This citation pertains to intakes 2656662 and 2661216Based on observation, interview, and record review,

the facility failed to ensure meals were served at palatable temperatures in two of two records reviewed, resulting in decreased food consumption and potential nutritional decline.Findings Include:It was reported to the State Agency that food served to the residents was not at palatable temperatures.On 1/27/2025 at 11:57 AM, an interview with Dietary Manager F found that the facility has heated bases, but they are not in use for today's meal. Further observation found plates between 75F-85F with no visible plate warmer being utilized. When asked what she expects for hot food on the steam table, DM F stated that it should be at least 150F so that residents can get their food at 135F or higher.On 1/27/2025 at 12:09 PM, a regular test tray was plated and placed as one of the first meals on the C unit cart. On 1/27/2025 at 12:20 PM, the meal cart arrived on C unit with roughly 25 meal trays present. On 1/27/2025 at 12:37 PM, all trays were delivered, and the test tray was back in the conference room. The following temperatures were found using

a rapid read thermometer: Pot pie 127.6F and mixed vegetables 104F.

Residents Affected - Some

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

Event ID:

Facility ID:

If continuation sheet