Kalkaska Memorial Health Center
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to notify a resident's Power of Attorney (POA; a legal document that authorizes a trusted person, called an agent, to make legal, financial, and/or medical decisions on their behalf) of a change in condition in a timely manner for one Resident (#3) of three residents reviewed for notification of changes. This deficient practice resulted in an 8-hour delay in notifying
the POA of the resident's significant change in condition and the potential for delays in treatment.Resident #3 (Resident R3)A review of the Electronic Medical Record (EMR) revealed Resident R3 was admitted to the facility on [DATE REDACTED] with diagnoses including dementia with unspecified severity and other behavioral disturbance. On 5/9/25, Resident R3 was given a BIMS (Brief Interview for Mental Status) score of 5 out of 15 indicating severe cognitive impairment. Resident R3 also had a POA for medical care and financial decisions appointed to their daughter.The progress notes on 10/5/25 at 1:21AM indicated Resident R3 was found by staff sitting on floor next to bed. Resident (Resident R3) stated he went to sit up at edge of bed and slipped off.resident (Resident R3) while sitting at bedside stated his left hip hurt.received order for x-ray for bilateral hips and pelvis . Resident R3 was taken for x-rays at the hospital and diagnosed with displaced fractures of the left superior and inferior pubic rami (a break in two of the bones that form the front part of the pelvis).On 10/16/25 at 12:50PM, a phone interview was conducted with the POA for Resident R3, who stated they had not been called the night Resident R3 fell. The POA stated they would have liked to have been there for their father stating they believed Resident R3 must have been confused, and scared. The POA felt that her presence would have calmed Resident R3 and alleviated any fears. The POA stated the facility called on
the morning of 10/5/25 after the day shift nurse came on.Certified Nursing Assistant (CNA) D stated they were working the night Resident R3 fell. During a phone interview on 10/16/25 at 1:54PM, CNA D stated nursing staff were supposed to notify families when there is a change in condition.A phone interview was conducted on 10/16/25 at 2:27 PM with LPN F who was working the night Resident R3 fell, stated they did not call Resident R3's POA.A
review of the facility's Post Fall Documentation indicated Resident R3 fell on [DATE REDACTED] at 10:45PM. The section labeled Document family member notified along with time/date indicated Resident R3's POA was notified on 10/5/25 at 7:05AM. This documentation lacked any family/POA notifications at time of Resident R3's fall. This resulted in the guardian not being informed of the resident's significant change in condition for over 8 hours, potentially delaying decision-making and necessary interventions.The NHA stated, during an interview at 2:40 PM on 10/5/25, the facility does not have a specific policy about notifications for change in condition.
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.