Medilodge Of Farmington

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

wound was avoidable or unavoidable, or the plan of treatment for the wound. Resident R906's care plans were reviewed and revealed their first care plan for the wound to their left ankle was implemented on 7/29/25, despite the wound being discovered on 6/6/25.

On 9/3/25 at 1:38 PM, an interview was conducted with the facility's Director of Nursing, they acknowledged

the concern with Resident R906's facility acquired pressure ulcer. Resident R905

On 9/2/25 the medical record for Resident R905 was reviewed and revealed the following: Resident R905 was initially admitted to the facility on [DATE REDACTED], discharged on 8/3/25 and had diagnoses including Dysphagia and Gastrostomy status.

A review of Resident R905's Nursing admission Evaluation dated 7/29/25 revealed the following: Section V. Skin. A. 1.

Does the resident have any identified skin conditions/wounds? b. [No] .

A review of Resident R905's progress notes revealed the following: 8/1/2025-Nurses' Notes Writer and DON (Director of Nursing) assessed resident. Resident had MSAD (moisture associated skin damage) to coccyx, heals balanceable 8/3/2025-Nurses' Notes Resident has MASD skin tear on coccyx triad applied. redness on bilateral heels . pictures of coccyx were taken before discharge .

A Wound Evaluation dated 8/3/25 revealed the following: #1-Skin Tear-Category 1. Linear .Body Location: Right Gluteus .Acquired: Present on Admission. Dimensions: Area 0.63 cm (centimeters squared). Length 1.14 cm. Width 0.78 cm. Deepest point 0.1 cm Wound Bed epithelial [yes]. Periwound: Edges [non-attached]. Treatment: Dressing appearance [intact]. Cleansing solution [Generic wound cleanser].

Primary dressing [other]. Other, Specify: Triad.

Further review of Resident R905's wound picture on their 8/2/25 evaluation revealed the following: The picture showed an open area on the right gluteal fold that appeared to be in an area where friction and shear forces would be heightened. The picture also revealed cicatrix (scar of a healed wound) that mirrored the left gluteus.

A review of Resident R905's Physican orders did not reveal any treatment orders for the identified wound on their coccyx/right gluteus area.

A review of Resident R905's July and August 2025 TAR (treatment administration record) revealed no treatments to Resident R905's coccyx/right gluteus wound were administered during their stay in the facility.

On 9/3/25 at approximately 11:18 a.m., The DON was queried regarding the process for the identification of new skin impairments, and they indicated that when a skin impairment is identified, the Physican is notified, and new order tor treatment is put into the record for it and the careplan is updated. The DON was queired regarding Resident R905's wound that was identified on 8/1/25 and the wound evaluation that was done on 8/3/25 that indicated the wound was present on admission and they reported that a Physician's order should have been implemented to treat it and that it should have been implemented upon admission to the facility.

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

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

09/04/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Farmington

34225 Grand River Ave Farmington, MI 48335

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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

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 (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 Resident R905 was fed an incorrect amount of enteral formula. On 9/2/25 the medical record for Resident R905 was reviewed and revealed the following: Resident R905 was initially admitted to

the facility on [DATE REDACTED], discharged on 8/3/25 and had diagnoses including Dysphagia and Gastrostomy status. A review of Resident 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 Resident 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 Resident R905 and the error of Resident 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 Resident R905 being over fed on 7/31/25. Nurse A reported that after they got shift report then went into Resident R905's room to check their tube feeding (enteral) and observed Resident 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, Resident 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

1. 7. 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

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

09/04/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Farmington

34225 Grand River Ave Farmington, MI 48335

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 0695

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

Level of Harm - Minimal harm or potential for actual harm

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 (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 Resident R904's responsible party and they expressed concerns regarding Resident R904's tracheostomy care.On 9/3/25 at 11:25 AM, Resident R904 was observed in bed. Resident 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 Resident 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.

Residents Affected - Few

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

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

09/04/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Farmington

34225 Grand River Ave Farmington, MI 48335

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 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

On 9/2/25 at 9:40 AM, Resident 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 Resident R903 was readmitted to the facility on [DATE REDACTED] with a medical diagnosis of Alzheimer's disease and muscle weakness. A further review of the record revealed that Resident 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 Resident R903's wounds from

the beginning of the admission to current.

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

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

Event ID:

Facility ID:

If continuation sheet