Medilodge Of Southfield

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0550 during a standard health inspection conducted on 2025-08-15.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0558 during a standard health inspection conducted on 2025-08-15.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Reasonably accommodate the needs and preferences of each resident.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

F 0570

Assure the security of all personal funds of residents deposited with the facility.

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 #1194668.Based on record review and interview, the facility failed to purchase a surety bond in an amount equal to the current balance of personal funds held in the resident trust fund. This deficient practice has the potential to affect 82 resident's that have funds managed by the facility. Findings include:On [DATE REDACTED] at 2:24 PM, the facility was requested to provide a list of residents that have personal funds managed by the facility (resident trust fund), and the facility's surety bond (an agreement between the principal [the facility], the surety [the insurance company], and the oblige [either the resident or the State acting on behalf of the resident], wherein the facility and the insurance company agree to compensate the resident (or the State on behalf of the resident) for any loss of residents' funds that the facility holds, safeguards, manages, and accounts for).Review of the documentation provided revealed the provided list of residents that had current balances as of [DATE REDACTED] included Total Accounts: 82 .Current balance $63,240.36 .The facility's surety bond which was dated [DATE REDACTED] - [DATE REDACTED] documented it was only for $45,000.00.On [DATE REDACTED] at 8:32 AM, an interview was conducted with the Business Office Manager (Staff ‘H‘) who reported

they had been in their role for about a year. When asked about the residents included on the documentation that had money in the facility's resident trust fund, Staff ‘H' confirmed there was at least one resident that had expired [DATE REDACTED] but was still showing as having funds. They reported they were not sure why that happened and would follow-up. When asked about the surety bond amount which was much lower than the current balance for [DATE REDACTED], Staff ‘H' reported they would follow-up.On [DATE REDACTED] at 10:40 AM, Staff ‘H' provided additional documentation and reported the trust fund balances from previous months were lower than $45,000 and further reported they had not processed the patient pay amounts for the month of August yet, so it would be lower amount that what it was showing. Staff ‘H' was asked if there was a specific date

the resident's patient pay amounts were removed for payment and they indicated there was not, and it varied. They were informed the current surety bond provided did not cover the current balance and remained a concern.On [DATE REDACTED] at 1:15 PM, Staff ‘H' reported the facility's trust fund balance documentation of previous months were under $45,000 and they were still waiting to process patient pay amounts for the month. When asked if that usually occurs on a specific date, Staff ‘H' stated the dates varied for multiple residents. Staff ‘H' was informed the concern remained since the current balance of the resident trust fund was significantly higher than the amount of the surety bond.On [DATE REDACTED] at 9:44 AM, the facility was requested to provide a policy regarding the surety bond. At 9:59 AM, the Administrator reported they did not have a policy regarding surety bond.

Residents Affected - Many

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Southfield

26715 Greenfield Rd Southfield, MI 48076

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)

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0585 during a standard health inspection conducted on 2025-08-15.

Category: Resident Rights Deficiencies

The facility was found deficient in the following area: Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

queried regarding the mostly blank discharge forms for both Resident R172 and Resident R173 and the lack of clinical information that was provided up on discharge and they indicated that they did identify the same issue around that time with facility staff failing to complete the discharge form, SWD C reported that each discipline in the facility should have filled out their sections completely. On 8/13/25 a facility document titled Discharge Planning Process was reviewed and revealed the following: Policy: It is the policy of this facility to develop and implement an effective discharge planning process that focuses on the resident's discharge goals, the preparation of residents to be active partners and effectively transition them to post-discharge care, and the reduction of factors leading to preventable readmissions 1. Upon discharge of a resident (other than in emergency to hospital or death) a discharge summary will be provided to the receiving care provider. The Discharge Summary should include a. An overview of the resident's stay that includes but not limited to: diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results' b. A final summary of the resident's status at the time of discharge that is available for release to authorized persons and agencies, with the consent of the resident or resident's representative. c.

Reconciliation of all pre-discharge medications with the resident's post discharge medication to include prescription and over the counter medications

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Southfield

26715 Greenfield Rd Southfield, MI 48076

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 0677

On 8/4 evening shift (blank);

Level of Harm - Minimal harm or potential for actual harm

On 8/5 day shift (blank);

On 8/6 day shift (blank);

Residents Affected - Some

On 8/9 day and evening shift (blank);

On 8/10 day shift (blank);

On 8/11 day and evening shift (blank).

On 8/14/25 at 11:30 AM, an interview was conducted with the Director of Nursing (DON). When asked about the facility's expectations for documenting resident care provided, the DON reported it should be put

in as “real time” (when care was actually provided).

When asked if the EMR system alerted the facility if there were missed opportunities for ADL documentation and they reported in the morning they get a report that shows a percentage per unit and the expectation is to have better than 85% and should flag if for example no shower was given or if it was refused.

The DON then pulled up the task sections of the EMRs for both Resident R8 and Resident R138 and reported they saw the same limited documentation for bathing, incontinence care and oral care.

When asked what should happen if a resident refused care such as bathing, incontinence care, or oral care and the DON stated anyone who refuses should immediately let the nurse know and then follow up later.

The DON further stated “We usually ask three times.” The DON reviewed Resident R8's oral care documentation of refusals and when asked why it was marked as No for if oral care was provided but not noted as refused, and also about all the refusals or “No” responses were from the same CNA (CNA ‘E’) the DON reported they had no idea and would have to follow-up with that CNA.

On 8/14/25 at 1:17 PM, a phone interview was conducted with CNA ‘E’. When asked about their documentation of “No” oral care and refusals, CNA 'E' reported the resident did not allow them to brush their teeth and always refused for them. When asked what they did when the resident refused oral care, i.e., did they notify anyone, CNA 'E' reported they no, they just documented refused and “No” in the electronic medical record.

According to the facility's policy titled, Activities of Daily Living (ADLs) dated 12/28/2023: .A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene .

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

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Southfield

26715 Greenfield Rd Southfield, MI 48076

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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

when she was first admitted on Friday [DATE REDACTED], then when she came back on Saturday [DATE REDACTED], Resident R175 was different, her BS was elevated and her HR was high… called the doctor, who ordered an x-ray… was surprised it was negative for pneumonia, knew something was not right, then on Sunday [DATE REDACTED] her breathing got worse. RN “Q” was asked if she took vitals as none were documented. RN “Q” explained she did, must not have put them in the computer.

On [DATE REDACTED] at 10:10 AM, LPN “R”, who was Resident R175’s day shift nurse on [DATE REDACTED] and [DATE REDACTED], was interviewed by phone and asked if he had taken Resident R175’s vitals. LPN “R” explained he “always” took vitals before giving medications. When informed there were no vitals documented for Resident R175, LPN “R” had no answer. LPN “R” was asked if Resident R175’s HR had been elevated. LPN “R” explained he thought her HR at baseline was

a little elevated, like 90 to 100. When informed Resident R175 had been sent to the hospital with Septic Shock, LPN “R” explained he never saw any symptom of Septic Shock, she had been stable. LPN “R” was asked if any Medical Provider had seen Resident R175 on her first admission. LPN “R” explained usually there are no Medical Provider’s that come to the facility on the weekends.

Review of a facility policy titled, “Notification of Changes” revised [DATE REDACTED] read in part, “…Circumstances requiring notification include: 1. Accidents… 2. Significant change in the resident’s physical, mental, or psychosocial conditions such as deterioration in health, mental or psychosocial status… 3. Circumstances that require a need to alter treatment… 4. A transfer or discharge of the resident from the facility…”

The Immediate Jeopardy that began on [DATE REDACTED] was removed and the deficient practice corrected on [DATE REDACTED] when the facility took the following actions to remove the immediacy. The facility assessed current residents for a change in condition by reviewing labs and vital signs. Education was provided to nursing staff on assessment, notifying the physician and implementing orders and documentation.

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

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Medilodge of Southfield

26715 Greenfield Rd Southfield, MI 48076

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)

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0686 during a standard health inspection conducted on 2025-08-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0690 during a standard health inspection conducted on 2025-08-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0695 during a standard health inspection conducted on 2025-08-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide safe and appropriate respiratory care for a resident when needed.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

F 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

resident wanted a specific lift (this was not identified in the resident's clinical record - in progress notes, care plans, or social service assessments). SSD ‘C' reviewed the documentation available for Resident R138 and confirmed there was no other details included as to what facilities had been attempted, or any other specifics details. SSD ‘C' reported they would follow-up with Staff ‘D', however there was no further follow-up or documentation provided by the end of the survey.According to the facility's policy titled, Discharge Planning Process dated 10/20/2023: .The facility will support each resident in the exercise of his or her right to participate in his or her care and treatment, including planning for discharge .The facility will document any referrals to local contact agencies or other appropriate entities made for the purpose of the resident's interest in returning to the community .The facility will update a resident's comprehensive care plan and discharge plan, as appropriate, in response to information received from referrals to local contact agencies or other appropriate entities .The facility will assist residents and their resident representatives in choosing an appropriate post-acute care provider (i.e. another SNF .that will meet the resident's needs, goals and preferences .The Social Services Director, or designee, shall compile available data as needed

on other post-acute care options to present to the resident, including, but not limited to .Data on providers within the resident's desired geographic areas, where available .

Event ID:

Facility ID:

If continuation sheet

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0761 during a standard health inspection conducted on 2025-08-15.

Category: Pharmacy Service Deficiencies

The facility was found deficient in the following area: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0791 during a standard health inspection conducted on 2025-08-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide or obtain dental services for each resident.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0804 during a standard health inspection conducted on 2025-08-15.

Category: Nutrition and Dietary Deficiencies

The facility was found deficient in the following area: Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-08-15.

Category: Nutrition and Dietary Deficiencies

The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0865 during a standard health inspection conducted on 2025-08-15.

Category: Administration Deficiencies

The facility was found deficient in the following area: Have a plan that describes the process for conducting QAPI and QAA activities.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.

Federal health inspectors cited Medilodge of Southfield in Southfield, MI for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-08-15.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 17 deficiencies cited during this inspection of Medilodge of Southfield.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-09.