Medilodge Of Livingston

F 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This citation pertains to Intake #2584966Based on observation, interview and record review the facility failed to ensure residents received scheduled showers for one (Resident R801) out of one resident reviewed for ADL (activities of daily living) care. Findings include:A complaint was filed with the State Agency (SA) that alleged there were not enough staff at the facility to ensure they received their showers.On 8/27/25 at approximately 9:30 AM, Resident R801 was observed lying in bed. The resident was alert and able to answer all questions asked. When quired as to whether they received scheduled showers, Resident R801 replied that they finally got a shower yesterday (8/26/25) but was not regularly receiving them and often only received a bed bath. Resident R801 noted that they need a shower to ensure cleanliness.A review of Resident R801's clinical record revealed the resident was initially admitted to the facility on [DATE REDACTED] with diagnoses that included: type II diabetes and acute respiratory failure. A review of the resident's Minimum Data Set (MDS) dated [DATE REDACTED] noted the resident had a Brief

Interview for Mental Status (BIMS) score of 14/15 (intact cognition).A review of review of Resident R801's TASK

record for showers noted the resident was to receive showers on Tuesday and Fridays during the day shift.

A 30 day look back recorded the following: Tuesday- 7/29/25 (shower), Friday -8/1/25 (bed bath), Tuesday -8/5/25 (bed bath), Friday-8/7/25 (nothing provided), Tuesday-8/12/25 (nothing provided), Friday-8/15/25 (shower), Tuesday-8/19/25 (bed bath), Friday-8/22/25 (nothing provided) and Tuesday-8/26/25 (shower). *It should be noted that there were no notes that indicated Resident R801 refused showers on the dates nothing was provided. In addition, there were no notes that indicated Resident R801 preferred a bed bath on the dates noted above.On 8/27/25 at approximately 3:30 PM, an interview was conducted with Certified Nursing Assistant (CNA) F who was assigned to Resident R801. CNA F was asked about the facility's protocol pertaining to showers.

CNA F reported that showers generally are given twice per week. CNA F was asked if they provided Resident R801 with showers and/or bed baths and they noted that they give the residents showers as that is what they prefer.A request had been made for any grievances pertaining to Resident R801. On 8/27/25 at approximately 3:40 PM, the Administrator reported that a grievance pertaining to showers was submitted yesterday (8/26/25) and had not been fully completed.

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

08/27/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Livingston

3003 W Grand River Howell, MI 48843

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

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

Respiratory Director (RTD) 'E'. When queried about the progress notes documenting put on previous vent settings instead of documenting the vent settings, RTD 'E' said they were short of staff and probably did it to save time. When queried about the process for assessing a resident on a mechanical ventilator on admission and whether vital signs should be taken at the time of the assessment, RTD 'E' said they should.

When queried about how residents on mechanical ventilators were assessed when given a breathing treatment, RTD 'E' said the RT took breath sounds and vital signs before the treatment was administered and then they would go back in after the treatment and recheck breath sounds and redo the vital signs. At that time, the breathing treatment evaluations from 8/10/25 and 8/11/25 were reviewed with RTD 'E'. RTD 'E' reported they used the previous set of vitals taken by nursing. When queried about how the RT would know if the breathing treatment was effective if they used vital signs from eight to 14 hours earlier, RTD 'E' reported they should be taken at the time of the breathing treatment.

Event ID:

Facility ID:

If continuation sheet