Greentree Of Hubbell Rehabilitation And Health

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

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

Resident R4's appearance was unchanged from 9/16/25 at 12:10 PM to 9/16/25 at 4:00 PM.Review of a facility policy titled: Promoting/Maintaining Resident Dignity with a revision date of 8/2/25 read in in part as: Policy:

It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances residents quality of life by recognizing each residents individuality. Compliance Guidelines: 1. All staff members are involved in providing care to residents to promote and maintain resident dignity and respect resident rights .Review of a facility job description titled: Certified Nursing Assistant revealed: Position Purpose Provides certified nursing assistant services to assigned residents in accordance with care plans, facility policies and procedures and at the direction of supervisor(s). Major Duties and Responsibilities Provides supportive services to nurse(s) and other staff as needed and performs duties as assigned. Assists resident with or perform activities of daily living for residents in accordance with care plans and established policies and procedures. Assists resident with lifting, turning, moving, positioning, and transporting into and out of beds, chairs, bathtubs, wheelchairs, lifts, etc. Coordinates dining room services at assigned mealtimes, including set-up and clean-up, meal tray delivery, feeding assistance, and documentation of meal intake. Delivers nutritional supplements to residents at assigned times and provides assistance as necessary to ensure intake. Documents intake accordingly.

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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

09/16/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greentree of Hubbell Rehabilitation and Health

52225 B Avenue Hubbell, MI 49934

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 - Actual harm Residents Affected - Few

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

the EMR.Review of Resident R5's Care Plan read in part: I have a nutritional problem or potential nutritional problem.

Date Initiated: 03/28/2025.I like coffee with all meals, like it black, ensure it is in a 2 handled cup with lid.

Date Initiated: 03/28/2025.Review of Resident R5's progress notes read in part: 9/12/2025 09:39 IDT (interdisciplinary team) Note Text: IDT reviewed resident's coffee burn incident. handled spout cup with lid for coffee has been implemented. Staff education provided. OT .Review of Resident R5's progress notes read in part: 9/12/2025 12:10 Secure Conversations Messages: Subject: interventions for burns 9/12/2025 09:38 AM ADON -may we have an order for 2 handled spout cup with lid for coffee?In a phone interview on 9/16/25 at 5:10 PM., CNA J reported last week Resident R5 was burned by hot coffee because she (CNA J) was running around trying to get everyone set up for breakfast and the facility was short staffed. CNA J reported Resident R5 was seated at the dining room table, and she (CNA J) went to get coffee for her, the kitchen handed her a cup of coffee, and she knew it was too hot, so she went to get ice cubes and a lid because Resident R5 was supposed to have a lid on her coffee. CNA J reported she added the ice cubes; while walking back to get a lid for the coffee she was distracted by another resident needing something and she (CNA J) just dropped off the cup of coffee to Resident R5 without putting a lid on it. CNA J reported another staff noticed she (Resident R5) was wet, and she shouldn't have been because she was just changed before breakfast. CNA J realized the cup of coffee was spilled and Resident R5 was taken back to her room, and it was noticed initially there was red on her breast, and right stomach which then went all the way down to her upper legs which had some immediate blistering on her left thigh. CNA J stated I take full responsibility for that mistake, I have no problem admitting I made a mistake. I made the mistake because we don't have enough staff to manage that many residents on our daily assignments, and remember everything, it is impossible to do that under the conditions we are working. I am so sorry.I feel absolute horrible .

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

09/16/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greentree of Hubbell Rehabilitation and Health

52225 B Avenue Hubbell, MI 49934

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 - Some

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

shouldn't have been because she was just changed before breakfast. CNA J realized the cup of coffee was spilled and Resident R5 was taken back to her room, and it was noticed initially there was red on her breast, and right stomach which then went all the way down to her upper legs which had some immediate blistering on her left thigh. CNA J stated I take full responsibility for that mistake, I have no problem admitting I made a mistake. I made the mistake because we don't have enough staff to manage that many residents on our daily assignments, and remember everything, it is impossible to do that under the conditions we are working. I am so sorry.I feel absolute horrible . According to [NAME], [NAME] A.; [NAME], [NAME] Griffin; Stockert, [NAME]; Hall, [NAME]. Fundamentals of Nursing - E-Book (Kindle Locations 1589-1592). Elsevier Health Sciences. Kindle Edition.Time management, therapeutic communication, patient education, and compassionate implementation of bedside skills are just a few of the essential skills you need. It is important for your patients to leave the health care setting with a positive image of nursing and a feeling that they received quality care. Your patients should never feel rushed. They need to feel that they are important and are involved in decisions and that their needs are met .

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