Kalkaska Memorial Health Center
Inspection Findings
F-Tag F0689
F 0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Level of Harm - Actual harm Residents Affected - Few
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This citation pertains to intake: 2621196Based on interview and record review, the facility failed to follow fall interventions for one Resident (#4) of five residents reviewed for falls. This deficient practice resulted in a fall with major injury requiring surgery. Findings include: Resident #4 (Resident R4)Review of Resident R4's Electronic Medical
Record (EMR) revealed admission to the facility on 6/25/24 with diagnosis including above right knee amputation, dementia, and hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. Review of Resident R4's Minimum Data Set (MDS) assessment dated [DATE REDACTED] showed a Brief
Interview for Mental Status (BIMS) score of 14/15 indicating Resident R4 was cognitively intact. Section GG of the MDS showed Resident R4 required max assistance for toileting and transfers. Resident R4's Fall Risk Evaluation dated 11/21/24 showed a score of 13, indicating a high risk for falls.Review of Resident R4's Progress Note dated 9/9/25 and 9/10/25 read, in part, Approx. (approximately) 9:40 p.m. this nurse called to (Resident R4's room) resident was laying on the floor on her back, resident stated she was on the toilet and stood up by herself to grab a brief and lost her footing and fell.Resident assessed and c/o (complaint of) right hip pain, this nurse phoned E.D (Emergency Department) and gave report.and this nurse sent resident to the E.D. for x-rays and evaluated [sic].fall was unwitnessed. 9/10/25 Approx. 12:20 a.m.,.E.D. called this nurse and resident does have a fractured right hip and is being transferred to [Hospital Name].A witness statement from Certified Nurse Aide (CNA) A dated 9/9/25 read, in part, I had gone into (Resident R4's) room and told her I would be in ASAP (as soon as possible) to get her in the bathroom. It was super busy and I was way behind. I was also trying to get help to turn [Resident room number].I didn't want (Resident R4) to have to wait any longer so I put her in the bathroom and went to [Resident room number] with CNA B. CNA B walked out and went straight to (Resident R4) and found her on the floor.Review of Resident R4's Care Plans read, in part, .The resident is AT risk for falls r/t (related to ) deconditioning dx (diagnosis) right AKA (above knee amputation).Do not leave alone in BR (bathroom) date initiated 10/10/24When CNA A was asked by facility staff if they were aware of Resident R4's care plan intervention to not leave alone in the bathroom, CNA A stated she was not.An interview conducted with the Nursing Home Administrator (NHA) and Director of Nursing (DON) on 9/19/25 at approximately 10:45 a.m. confirmed that CNA A did not follow Resident R4's care plans which contributed to Resident R4's fall and fracture.
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:
Kalkaska Memorial Health Center in Kalkaska, MI inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Kalkaska, MI, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Kalkaska Memorial Health Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.