Medilodge Of Farmington

Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY This citation pertains to intake #2579668Based on interview and record review, the facility failed to ensure enteral feeding orders were accurately transcribed upon admission and administered correctly for one resident (R905) of two residents reviewed for enteral feeding.

Findings include:On 9/2/25 a complaint submitted to the State Agency was reviewed that alleged R905 was fed an incorrect amount of enteral formula. On 9/2/25 the medical record for R905 was reviewed and revealed the following: R905 was initially admitted to the facility on [DATE], discharged on 8/3/25 and had diagnoses including Dysphagia and Gastrostomy status. A review of R905's initial admission hospice Physician orders revealed the following: Evaluate need for supplemental tolerance of Glucerna 1.2 at 40ml/hr (milliliters per hour) for 16 hours.A review of R905's transcribed admission enteral orders revealed the following: Enteral Feed Order every morning and at bedtime every shift Glucerna @45ml/hr (milliliters per hour) x 16hrs via peg tube (percutaneous endoscopic gastrostomy tube) or until a total volume of 720ml. -Start Date- 07/30/2025 0700A progress note dated 7/31/2025 at 08:13 a.m., revealed the following: Received resident in bed with eyes open and resting with family at bedside.

Resident feeding was currently running total volume infused when writer stop feeding was 1191 (milliliters), total volume to be infused was 720 ml.

Resident abdominal area was hard and distended.

Writer pulled 1000cc with residuals.

Writer notified on call NP (Nurse Practitioner), who ordered to hold tube feeding and get STAT (immediately) x ray of abdomen.

Writer notified DON (Director of Nursing) and on coming nurse of this change.On 9/3/25 at approximately 11:18 a.m., The Director of Nursing (DON) was queried regarding the enteral feeding order for R905 and the error of R905 being overfed on 7/31/25.

The DON indicated they were aware of the error and that they had done an in-service with the Nursing staff on ensuring enteral orders are administered appropriately. On 9/3/25 at approximately 2:24 p.m., Nurse A was queried regarding R905 being over fed on 7/31/25.

Nurse A reported that after they got shift report then went into R905's room to check their tube feeding (enteral) and observed R905 to have over what they were supposed to have.

Nurse A indicated they had to stop the tube feeding pump and called the medical provider who ordered to hold the tube feeding.

Nurse A reported that due to the overfeeding, R905's abdomen was distended.

Nurse A indicated that the facility enteral pumps had to be set with a stop time otherwise the pump would keep running.

Nurse A reported that they informed the Director of Nursing of the error. On 9/4/25 a facility document titled Feeding Tubes was reviewed and revealed the following: Policy: Feeding tubes will be used only as necessary to address malnutrition and dehydration, or when the resident's clinical condition deems this intervention medically necessary to maintain acceptable parameters of nutrition and hydration.

Feeding tubes will be maintained in accordance with current clinical standards of practice, with interventions to prevent complications to the extent possible

• Feeding tubes will be utilized according to physician orders .11.

Direction for staff regarding nutritional products and meeting the resident's nutritional needs will be provided to include: e.

Ensuring that the administration of enteral nutrition is consistent with and follows the practitioner's orders

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/04/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Farmington

34225 Grand River Ave Farmington, MI 48335

SUMMARY STATEMENT OF DEFICIENCIES

Provide safe and appropriate respiratory care for a resident when needed.

This citation pertains to intake #2580612Based on observation, interview, and record review the facility failed to assess and provide tracheostomy care per physician's orders for one resident (R906), of one resident reviewed for respiratory care, resulting in the potential for tracheostomy complications.

Findings include: On 9/3/25 at 10:44 AM, an interview was conducted with R904's responsible party and they expressed concerns regarding R904's tracheostomy care.On 9/3/25 at 11:25 AM, R904 was observed in bed. R904 was in a vegetative state, non-verbal, did not track with their eyes and was observed to have a tracheostomy.On 9/3/25 at 11:55 AM a review of R904's physician's orders, medication administration records (MAR) and treatment administration records (TAR) was conducted and revealed missing documentation for assessment of the stoma site under the tracheostomy collar and tracheostomy care on the following dates/times:Day shift 6/9/25, 6/22/25 thru 6/26/25, 6/29/25 and night shift 6/4/25 and 6/6/25.Day shift 7/22/25 and 7/23/25, and night shift 7/10/25.Day shift 8/7/25 and night shift 8/21/25.On 9/3/25 at 1:38 PM, an interview was conducted with the facility's Director of Nursing.

They indicated tracheostomy care had been transferred over from respiratory therapy staff to nursing staff and that could have been part of the reason the treatments were not done as nursing may have thought respiratory therapy provided the care.A review of a facility provided policy titled, Tracheostomy Care was conducted and read, .1.

Respiratory therapy or trained and competent personnel will provide and document tracheostomy care to all residents with a tracheostomy twice within 24 hours.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/04/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Farmington

34225 Grand River Ave Farmington, MI 48335

SUMMARY STATEMENT OF DEFICIENCIES

On 9/2/25 at 9:40 AM, R903's skin was observed. A dark wound was present on the left heel and an open area that was a whiteish pink in color was observed located on the left buttocks.

On 9/2/25 a record review was completed and showed that R903 was readmitted to the facility on [DATE] with a medical diagnosis of Alzheimer's disease and muscle weakness. A further review of the record revealed that R903 had a wound care assessment completed and a wound care consult order in.

On 9/2/25 at 9:48AM, the wound care coordinator (WCC) was interviewed. WCC was asked who oversees the wounds at the facility, the WCC reported, they were recently hired into the role, but that primary care provider oversaw wound care until the facility hired a provider.

The WCC was then asked who did the weekly wound rounds and provided further guidance if needed to the facility.

The WCC reported that they completed weekly rounds with themselves and usually another staff member until the facility hired a provider, but it was no one over looking the wounds.

The WCC was asked, had they personally rounded with the primary care providers at the facility for individuals with wounds, the WCC reported no.

On 9/2/25 at 10:06 AM, an interview with the DON and Administrator were conducted, they were asked who oversaw the wounds at the facility.

The DON reported that the primary care provider is supposed to oversee the care for wounds.

The administrator and DON were asked when the last time they had a Wound Care provider, the DON reported that since late May or early June they had been without.

The DON was then asked for the oversite, notes or any documentation from the medical provider for R903's wounds from the beginning of the admission to current.

There was no additional documentation provided by the exit of the survey.

Facility ID: