The Springs At Rochester Hills Rehab And Nursing C

F 0600 Level of Harm - Actual harm Residents Affected - Few

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

got mad and I saw her hit [Resident R803] on the arm. She [Resident R802] kept hitting her. I said to [Resident R802] you have to understand because [Resident R803] just doesn't understand.When asked to confirm if they were assigned to that unit with Resident R802 and Resident R803, Nurse ‘B' reported on that day (9/26/25) they worked on the first floor. Nurse ‘B' further reported, I came upstairs and that's when I saw the interaction between the two residents. When asked if they could recall the time it occurred, Nurse ‘B' stated, I wanna say it was probably after dinner, because I had just took my lunch break. I remember it was still light outside.On 10/7/25 at 1:20 PM, a phone interview was conducted with Nurse ‘E'. When asked to recall their events of the incident between Resident R802 and Resident R803, Nurse ‘E' reported, [Resident R802] was my resident and the resident that got hit [Resident R803] was not my resident. Was in middle of med pass and turned and looked and when seen resident {Resident R803] on the ground, [Resident R802] was thinking another resident was her husband and [Resident R802] knocked her on the floor.[Resident R802] been having a mental status change, this is new for her. When asked if they were aware of any other incidents between Resident R802 and Resident R803, Nurse ‘E' reported, Believe it was probably just one. Heard about a resident to resident with [Resident R802] sometimes she can be aggressive with other residents. I don't know. I think I can recall hearing something of hers from another nurse on another shift, or her past history. Just happened the other day. Don't want to speak on something I overheard.On 10/7/25 at 1:27 PM, a phone interview was conducted with Nurse ‘T'. When asked to recall their events of the incident between Resident R802 and Resident R803, Nurse ‘T' reported, I was assigned to [Resident R803]. I was down the hall at the med cart and the other nurse I heard her yell out for me cause I heard a bump. She yelled out [Nurse ‘T's' name] and I looked down and [Resident R803] had both hands on the floor and her head was on the wall a bit. [Resident R802] was kicking at her. It wasn't hard, only so much she can do in her wheelchair. I'm not sure how she got on the floor but ran down to separate them.When asked if they were familiar with Resident R802 and Resident R803's behaviors and if they were aware of any other instances between the two residents, Nurse ‘T' reported they were not.Nurse ‘T' further reported the hospice nurse came onsite to evaluate the resident and there was a small area in her eyebrow.On 10/7/25 at 2:40 PM, an interview was conducted with the Administrator (who also was the facility's Abuse Coordinator) and the Director of Nursing (DON). When asked to explain the details of the incidents between Resident R801 and Resident R802, the Administrator deferred to the documentation provided in their investigation file and what was reported to the State Agency.When asked about how it was determined the facility was not able to substantiate actual abuse had occurred between Resident R801 and Resident R802, the Administrator deferred to the documentation in their investigation file and State Agency portal and offered no further details. When asked about the discrepancies within the witness statements of what was actually witnessed and what was included in the investigation, they acknowledged the discrepancies but were not able to provide any additional explanation.According to the facility's policy titled, Abuse and Neglect dated 6/28/2025: .Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish.Willful, as used in this definition of abuse means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.Physical abuse includes but not limited to infliction of injury that occur other than by accidental means. Examples: hitting, slapping, kicking, squeezing, grabbing, pinching, punching, poking, twisting, roughly handling.

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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

10/07/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Springs at Rochester Hills Rehab and Nursing C

1480 Walton Blvd Rochester Hills, MI 48309

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

reported it was within the last 2 weeks and reported, It was Friday 26th, the afternoon shift. That's when the incident between [Resident R803] and [Resident R802] happened. She [Resident R802] got mad and I saw her hit [Resident R803] on the arm.

She [Resident R802] kept hitting her. I said to [Resident R802] you have to understand because [Resident R803] just doesn't understand.When asked to confirm if they were assigned to that unit with Resident R802 and Resident R803, Nurse ‘B' reported on that day (9/26/25) they worked on the first floor. Nurse ‘B' further reported, I came upstairs and that's when I saw the interaction between the two residents. When asked if they could recall the time it occurred, Nurse ‘B' stated, I wanna say it was probably after dinner, because I had just took my lunch break. I remember it was still light outside. On 10/7/25 at 2:40 PM, an interview was conducted with the Administrator (who also was the facility's Abuse Coordinator) and the Director of Nursing (DON). When asked to explain the timeline of events regarding when and who was notified of the incident on 9/20/25 between Resident R801 and Resident R802, the Administrator reported when they got the call, they were at a concert and it was a little while after the incident occurred when the Administrator talked to their boss initially and said no injury so it didn't need to be reported right away. The Administrator reported they had been notified by Regional Nurse Consultant (RNC ‘O'). The Administrator further reported they didn't report it right away until

after the concern because they were told there was no injury, so that was the reason they didn't report within two hours. They further reported they had not realized there was a fracture and so once they became aware of that, that was when it was reported.When asked about to explain their understanding of the reporting requirements, the Administrator offered no explanation and reported they were sure that would be explained when they received the citation.When informed about an interview with nursing staff during this survey who reported they witnessed an instance of additional resident to resident physical abuse between Resident R802 and Resident R803 from 9/26/25 as well as the Nurse confirming they did not report it, the Administrator and DON expressed frustration given the recent education they had done with staff.When asked how the facility ensured their use of contracted (agency) nursing staff were informed of the facility's abuse protocols and expectations, the Administrator reported they did face to face and rounded up the whole house to provide education, including what to report and who to report it to. The DON acknowledged that nurses might reach out to them and not the Administrator, but the DON would then notify the Administrator. The Administrator reported the facility used two staffing agencies and deferred to the abuse training and tests included in the facility's investigation for Resident R801 and Resident R802. Review of undated staff signature sheet for meeting sign-ins for Abuse and Neglect Policy 1. Resident to Resident altercations included Abuse & Neglect / Elder Justice Act Quiz documentation from 9/22/25 - 10/1/25. There was no evidence that Nurse ‘B' had received any training/education from the facility.According to the facility's policy titled, Abuse and Neglect dated 6/28/2025: .REPORTING: All allegations and/or suspicions of abuse/neglect must be immediately reported to the facility Administrator or designee in the absence of the administrator.All allegations and/or suspicions of abuse must be reported to the Administrator immediately.All allegations of abuse will be reported to the appropriate State Agencies immediately after the initial allegation is received.The Administrator is the Abuse Coordinator. Preliminary Investigation Report: The abuse coordinator must submit a preliminary investigation report to the appropriate State Agencies immediately once assurances for the resident's or other resident's safety have been established. However, if the event that caused the allegation involved abuse or resulted in serious bodily injury, the allegation of abuse must be reported to appropriate state agencies immediately and not later than 2 hours after receiving the allegation of abuse or not later than 24 hours if the event that caused the allegation did not involve abuse and did not result in serious bodily injury.

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