Optalis Health And Rehabilitation Of Grand Rapids

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

sense of well-being, level of satisfaction with life, feeling of self-worth, and self-esteem. General Guidelines: Residents will be treated with dignity and respect at all times .When assisting with care, residents are supported in exercising their rights. For example, residents are: groomed as they wish to be groomed (hair styles, nails, facial hair, etc.), encouraged to attend the activities of their choice, including religious, political, civic, recreational, or social activities, encouraged to dress in clothing that they prefer, allowed to choose when to sleep and conduct activities of daily living. Residents' private space and property are respected at all times. Staff are expected to knock and identify themselves before entering residents' rooms .Demeaning practices and standards of care that compromise dignity are prohibited. Staff are expected to promote dignity and assist residents, for example: helping the resident to keep urinary catheter bags covered, promptly responding to a resident's request for assistance; and allowing residents unrestricted access to common areas open to the public unless this poses a safety risk for the resident .

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

policy dated 8/8/22 revealed, Policy Overview: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident .General Guidelines: Each resident's comprehensive person-centered care plan is consistent with the resident's rights to participate in the development and implementation of his or her plan of care, including the right to: Participate in the planning process, participate in establishing the expected goals and outcomes of care .The resident is informed of his or her right to participate in his or her treatment, and provide advance notice of care planning conferences .

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0558

Reasonably accommodate the needs and preferences of each resident.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review the facility to failed to ensure call lights were within reach for 1 (Resident #108) of 9 residents (reviewed for accommodation of needs, resulting in resident's inability to call for staff assistance with the potential for unmet care needs. Findings include: Resident #108Review of an admission Record revealed Resident # 108 was originally admitted to the facility on [DATE REDACTED] with pertinent diagnoses which included lack of coordination, epilepsy (seizure disorder), muscle weakness, and difficulty walking. Review of a Minimum Data Set (MDS) assessment for Resident #108, with a reference date of 8/2/25 revealed Section GG: Functional abilities: Resident #108 was dependent for toileting assistance, personal hygiene and required substantial/maximum assistance with dressing. In an interview and

observation on 8/14/25 at 10:26 AM, Resident #108 was sitting at the edge of his bed attempting to stand up on his own. Resident #108 was noted to be weak, and shaky as he attempted to stand. Resident #108 was stating over and over that he was ready to get up and needed help. This writer asked Resident #108 if

he could turn on his call light for staff to come help him, and he reported that he couldn't use his call light because he didn't know where it was. It was noted that Resident #108's call light was under his bed, and out of his reach. In an interview on 8/14/25 at 10:30 AM, Registered Nurse (RN) NN reported that Resident #108 was a high fall risk and had recently had unwitnessed falls in the facility. RN NN reported that Resident #108 did use his call light for staff assistance. Review of the facility's Call Light policy dated 8/16/23 revealed, Policy Overview: The purpose of this policy is to assure the facility is adequately equipped with a call light at each residents' bedside, toilet, and bathing facility to allow residents to call for assistance. Call lights will directly relay to a staff member or centralized location to ensure appropriate response. Guidance: Staff will ensure the call light is plugged in, functioning, within reach of residents, and secured, as needed .

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0603 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

locked unit, because her guardian did not want her on the locked unit. When this writer queried as to why Resident #109 was on the locked unit when she did not have a room on the unit, CNA JJ reported that the facility management had told staff that they were going to have Resident #109 do day care on the memory unit until her guardian consented to having her moved. CNA JJ reported that it did not make sense that Resident #109 was on the unit, because she enjoyed wandering, and she could not wander as much on the locked unit. CNA JJ reported that she had not observed Resident #109 exit seeking before. In an interview

on 8/13/25 at 12:45 PM: CNA Q reported that the facility had been placing Resident #109 in the locked unit until bedtime for awhile because they felt like with her wandering and behaviors, she needed more supervision. CNA Q reported that Resident #109 was considered a day care resident and went back to the main unit at night because her guardian did not want her on the locked unit. CNA Q reported that Resident #109 did wander a lot, but she had not observed her exit seeking. In an interview on 8/13/25 at 1:10 PM, Family Member/Guardian (FM) EE reported that the facility had been trying to talk him into moving Resident #109 to the locked unit for months, and he was not agreeable to this. FM EE reported that he felt like the facility was pushing him to allow Resident #109 into the locked unit because she was exit seeking but he felt the facility had not provided evidence of Resident #109 exit seeking. FM EE reported that he wanted to move Resident #109 to a new facility, and that he felt like having Resident #109 move to a new unit prior to moving to a new facility would create more stress and confusion for her, and he did not feel that moving Resident #109 to the locked unit was in her best interest. Resident #109 reported that the facility had mentioned trialing the locked unit with Resident #109 during their last care conference, and he again did not give the facility explicit consent to have Resident #109 on the locked unit during the day either. In an

interview on 8/13/25 at 1:36 PM, Director of Social Services (DOSS) HH reported that the facility was trialing Resident #109 on the locked unit during the day for additional supervision during the day. DOSS HH reported that the facility physician had assessed Resident #109 and felt that she would benefit from being

on that unit, and that the facility had an order to move her to the unit, but they were waiting on consent from Resident #109's guardian to do so. DOSS HH reported that she thought that FM EE had consented to allowing Resident #109 onto the locked unit during the day, but she was not able to confirm because she was not part of that conversation. In an interview on 8/18/25 at 12:56 PM, Director of Nursing (DON) B reported that she had tried to talk with FM EE about moving Resident #109 to the locked unit, but that he refused to discuss that with her over the phone. DON B reported that Resident #109 was not really on the unit because her room was not over there, but that they had her there during the day for her own safety.

DON B was not able to report how long the facility had been sending Resident #109 to the locked unit

during the day. DON B did not know if FM EE had given consent for Resident #109 to be on the locked unit

during the day. On 8/13/25 at 3:49 PM, This writer requested all verification of notification to Resident #109 to Nursing Home Administrator (NHA) A. NHA A provided Resident #109 care conference note dated 2/17/25, which was completed by the facility's former administrator. Review of Resident #109's Care Conference Note dated 2/17/25 revealed, Writer and DON had a phone care conference with Ombudsman and legal guardian (name redacted) regarding the transfer to the Dementia unit and after a half hour of speaking with guardian he still decided that he did not want his mother moved to the Dementia unit. he told all parties that he was going to move her to another facility as soon as he is able to . In an interview on 8/18/25 at 1:54 PM, NHA A reported that the facility was not able to provide any further documentation or verification that the facility had obtained consent from Resident #109's guardian to have her in the locked dementia unit during the day.

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0677

appropriate support and assistance with: Hygiene (bathing, dressing, grooming, and oral care, Mobility (transfer and ambulation, including walking), Elimination (toileting), Dining (meals and snacks) .

Level of Harm - Minimal harm or potential for actual harm 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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0684

then every hour X 4, then every 4 hours X 6, then every shift X 3 day .

Level of Harm - Minimal harm or potential for actual harm 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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

residents and was also inappropriate sexually and would try to grab at staff, kiss staff and ask for sex. LPN CC reported that staff had to monitor Resident #104 closely because of how quickly he could escalate and attempt to attack others. In an interview on 8/14/25 at 11:25 AM, CNA QQ reported that Resident #104 and Resident #109 both had a history of physical aggression towards other residents, and Resident #104 had a history of sexual aggression towards other residents and staff. CNA QQ reported that she had observed Resident #104 attempt to grab Resident #109, but could not recall when that happened, and just reported it was many moths ago. CNA 'QQ also reported that Resident #104 had attempted to kiss her and grabbed at her breasts recently, and she had a hard time redirecting Resident #104. In an interview on 8/13/25 at 2:03 PM, Nursing Home Administrator (NHA) A and Director of Nursing (DON) B confirmed that Resident #104 and Resident #109 had histories of being physically aggressive towards other residents, and that Resident #104 had a history of being sexually inappropriate towards females. DON B and NHA A reported that they expected nursing staff to ensure resident safety and that staff should not allow Resident #109 to sleep in Resident #104's room or be alone in a room with each other without staff supervision.

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

staffed. The Scheduler revised the Daily Assignment Sheet to further monitor and depict staffing assignments, levels, and changes.During this writer's interview with SC X, she confirmed that she is not responsible for monitoring staffing assignments, and that she is deferring to DON B. During this writer's

interview with DON B, she was not able to provide information on how the facility was adjusting staffing schedules and assignments when staffing changes occurred and reported that the facility was not experiencing staffing concerns. It was noted in observation and interview on 8/14/25 that the facility was working with less than 5 CNAs on the Coast unit, which was below minimum staffing levels. This writer requested staff schedules for 8/12/24-8/14/25 and 8/15/25-8/17/25. Nursing Home Administrator (NHA) A uploaded the written staff schedules for the dates requested. Review of the Staff Schedules for 8/12/24-8/14/25 and 8/15/25-8/17/25 noted that the schedules were printed but did not indicate if staff had actually worked the shift as scheduled. For further information related to staffing concerns, please see F-F550 and F-F677.

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

08/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Optalis Health and Rehabilitation of Grand Rapids

1950 32nd Street SE Grand Rapids, MI 49508

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 Optalis Health and Rehabilitation of Grand Rapids in Grand Rapids, MI for a deficiency under regulatory tag F-F0842 during a complaint investigation conducted on 2025-08-18.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Scope/Severity Level E: pattern, 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 9 deficiencies cited during this inspection of Optalis Health and Rehabilitation of Grand Rapids.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-11-17.