Medilodge Of Tawas City
Medilodge of Tawas City in Tawas City, MI — inspection on August 12, 2025.
Found 1 citation. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
dehiscence).
Review of the resident's Nurse Practitioner E's notes dated 6/21/25, revealed the surgical sites were well approximated (intact) with no signs of infection.
Review of the nursing progress note dated 7/4/25, stated Sternal incision noted to have eschar (dead narcotic wound tissue) with cracks in it; shorter L (left) lower leg incision (vein [NAME] site) covered with eschar and is not draining.
Review of the nursing progress note dated 7/6/25 (2 days after staff first noted eschar tissue), stated Sternal incision more open and will require close monitoring. No measurements of either site were documented by nursing.Review of nursing progress notes dated 7/4/25 through 7/7/25, revealed no complete wound assessment (no documentation at all of length, width, odor, warmth at site, discharge noted from wounds done by nursing with prompt transfer (when sternal and left leg wounds were found to have narcotic tissue on 7/4/25, no documentation of calling the Physician or NP upon observation of narcotic wound tissue (on 7/4/25), and delayed transfer to acute care for eschar tissue observed with infection which lead to sepsis (transferred to hospital for evaluation on 7/7/25, found narcotic dead tissue on 7/4/25).During a phone interview done on 8/12/25 at approximately 2:10 p.m., Nurse B was asked by this surveyor if she had called and informed the physician or NP on 7/4/25 and on 7/6/25, of the eschar tissue on the resident's sternum and she stated I don't remember calling them; I knew she had a up-coming appointment, I know she had labs done from the first time we sent her out for nose bleed (on 7/4/25, no hospital documentation of having observed the sternum or leg wound was found), I did not call for the labs.
Nurse B said she did not call anyone and inform them of the resident's eschar, because the resident had a appointment, she thought she could wait.
The resident had sepsis upon entry to the hospital emergency room from the infection of her sternal surgical wound.
During an interview done on 8/12/25 at approximately 10:15 a.m., Nurse Practitioner/NP E stated They (staff) did not inform me of the eschar in the sternum surgical wound or the left leg, they should have.
During an interview done on 7/12/25 at 12:11:00 p.m., Nurse Manager, RN C stated They (nursing staff) were considered about the nose bleeds, no one told me about the sternum wound or leg; they dropped the ball on that, I would have notified the provider.
During an interview done on 7/12/25 at 12:47 p.m., Nurse Educator, RN D stated No one informed me of the resident's condition, I would of thought the nurse would of informed somebody. I educate them on assessment and documentation.
During an interview done on 8/12/25 at approximately 11:40 a.m., Wound Nurse, LPN stated I do not take pictures, assess, monitor or document anything on surgical wounds, they (management) told me not too; I did not look at it.
During an interview done on 8/12/25 at 12:55 p.m., the facility Administrator stated, The evidence does support we did not follow the care plan.
Review of the facility Wound Treatment Management policy dated 10/26/23, stated Policy: To promote wound healing of various types of wounds, it is the policy of this facility to provide evidence-based treatments in accordance with current standards of practice and physician orders.
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