Douglas Cove Health And Rehabilitation

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

infection. Medication Order: Cephalexin (antibiotic).In an interview on 9/5/25 at 11:11 AM, DON B reported that the facility received updated wound orders on 9/3/25 from the community day center provider and it was discovered that there was a wound that the facility did not have in their records. DON B reported that Resident #104 had a diabetic ulcer on the bottom of his left foot, that had not been assessed, monitored or had wound care treatments on record, and now the resident was diagnosed with a skin infection. DON B reported that the wound was not documented on the skin assessments, but that the community day center did have documentation of it in their visit records. DON B reported that the facility is responsible for the resident's care and should ensure that weekly wound assessments, weekly full skin observations, and wound treatments are completed as necessary.Review of Resident #104's Wound Assessments revealed, no wound assessments for the left plantar foot. Review of Resident #104's Weekly Skin Review dated 9/1/25 revealed, Skin observation: Any new skin issues identified? No, Indicate sites below: (none listed), Progress note r/t (related to) current skin condition noted on assessment: no new skin impairments observed.Review of Resident #104's Visit Notes from the community day center dated 8/18/25 revealed, .PI (pressure injury) on left lateral ankle with dressing intact, no other dressings on. Left plantar foot (bottom) diabetic ulcer with thick scab, peri wound warm to touch and pink. Left 5th toe also scabbed and open to air.(RN N) checked in with (LPN E) to inform of above as well as concern with slight redness to left foot, need to keep sock on to protect. (LPN E) verbalizes understanding and states they will assess left foot routinely. Review of Resident #104's Visit Notes from the community day center dated 8/25/25 revealed, .check in on wounds and skin status.Has dressing on LLE (left lower extremity) dated 8/23/25. (RN N) removed all dressings. Diabetic ulcer on left plantar foot. Wound care provided.

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

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Douglas Cove Health and Rehabilitation

243 Wiley Road Douglas, MI 49406

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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

There was no record of the resident's stage 2 pressure ulcer on her coccyx and/or her stage 2 pressure ulcer on her right knee. Review of Resident #103's Weekly Skin Observations with the most recent skin

observation was documented on 8/12/25 revealed, Skin observation: Any new skin issues identified? No, Indicate sites below: (none listed), Progress note r/t (related to) current skin condition noted on

assessment

no new concerns.In an interview on 9/5/25 at 11:11 AM, Director of Nursing (DON) B reported that LPN E had forgotten to apply Resident #103's calcium alginate and would be disciplined for not following physician orders. DON B reported that Resident #103's care plan did not include all of her wounds and the CNA's use that as their direct care reference. DON B also reported that Resident #103 did not have weekly skin observations documented for the past 3 weeks.

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

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Douglas Cove Health and Rehabilitation

243 Wiley Road Douglas, MI 49406

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)

Federal health inspectors cited Douglas Cove Health and Rehabilitation in Douglas, MI for a deficiency under regulatory tag F-F0695 during a complaint investigation conducted on 2025-09-05.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide safe and appropriate respiratory care for a resident when needed.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 3 deficiencies cited during this inspection of Douglas Cove Health and Rehabilitation.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-29.