Regency At Troy

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

comfortable caring for (Resident R708) and they had no experience with tracheostomy's. LPN H was asked if the facility had the supplies to care for the resident and LPN H stated the resident came with supplies but was unsure of which supplies. LPN H stated they had no experience with tracheostomy either. LPN H explained

they found a nurse on another floor with tracheostomy experience and switched their assignments and assigned them to Resident R708. LPN H was asked why Resident R708 was transferred out the next day and LPN H replied Resident R708 could communicate by writing on a whiteboard. LPN H stated Resident R708 immediately noted that they needed suctioning upon admission, and the initial assigned nurse stated they did not know how to do it.

LPN H stated . It was a very scary situation because I wasn't comfortable. LPN H stated that Resident R708 noted on

the communication board . that he wasn't comfortable here (at the facility) and he was leaving tomorrow.

LPN H stated they notified the DON of the resident's admission and the DON asked them .who authorized

it (the admission) because I didn't. LPN H stated the facility was able to find staff experienced with tracheostomy care to be assigned to the resident until the resident was transferred out. No further explanation or documentation was provided by the end of the survey.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Regency at Troy

2685 West Maple Road Troy, MI 48084

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This citation pertains to intake: 2605657. Based on observation, interview and record reviews the facility failed to ensure bladder incontinence care was completed timely for one (Resident R702) of three residents reviewed for a urinary tract infection. Findings include:On 9/24/25 at 9:59 AM, Resident R702 was observed sitting up in bed. When asked, Resident R702 explained how they have been in and out of the hospital due to infections. Resident R702 explained how they are .always wet and sitting in wet diapers for hours. This is why I always get infections. Resident R702 stated they had not seen or met their Certified Nursing Assistant (CNA) for the day and the last time their brief was changed was by the night shift CNA at 6 AM. Resident R702 stated they were wet and had been laying in their wet brief for some time. At 10:24 AM, an interview was conducted with CNA A. When asked CNA A confirmed

they were assigned to Resident R702 for their shift. CNA A was asked what time they began their shift and CNA A replied at 7 AM. CNA A was asked how many residents they were assigned to for their shift and CNA A replied thirteen. CNA A was asked about not checking in with Resident R702 this morning regarding the bowel/bladder checks. CNA A was asked if it was normal for them to have been on duty for three and a half hours without checking in with their assigned residents to introduce themselves and to check on all assigned residents and CNA A replied they were actually late today but would check in on Resident R702 now. At 10:25 AM, CNA A was observed to have removed the brief of Resident R702. Resident R702's brief was soaked with urine.

The observation of the bed pad appeared to be dry, however dried urine stains were observed on Resident R702's bed sheets. CNA A stated they would remove the stained bedding and apply all new sheets. Review of a facility policy titled Routine Resident Care revised 3/12/25, documented in part . Residents receive the necessary assistance to maintain good grooming and personal/oral hygiene. Incontinence care is provided timely according to each resident's needs.A review of the medical record, revealed Resident R702 was admitted to

the facility on [DATE REDACTED], with a readmission date of 9/12/25 with medical diagnoses that included: Acute Pyelonephritis (infection of the kidneys), acute kidney failure- stage 3, endometriosis of the uterus, extended spectrum beta lactamase (ESBL) resistance, retention of urine, and the need for assistance with personal care.Further review of the medical record revealed Resident R702 was recently hospitalized on [DATE REDACTED] with

a diagnosis of sepsis secondary to urosepsis versus opiate overdose in the setting of AKI (acute kidney injury). Resident R702 was also recently hospitalized on [DATE REDACTED] with a diagnosis of pyelonephritis. A review CNA A time sheet revealed on 9/24/25, CNA A was noted as Tardy and clocked in at 8:00 AM. On 9/24/25 at 12:58 PM, the Director of Nursing (DON) was interviewed and asked about the CNA coverage for Resident R702 from 7:00 AM to 8:00 AM on 9/24/25 and the expectation of bowel and bladder checks for incontinent residents. The DON replied they would need to check on the CNA coverage for Resident R702 and acknowledged the expectation for bowel and bladder checks to be done every two hours and as needed for incontinent residents. On 9/25/25 at 2:09 PM, a follow up interview was conducted with the DON that identified a miscommunication regarding the CNA coverage for Resident R702, however verbalized an aide was assigned to Resident R702 until CNA A arrived on duty. The DON acknowledged the concern for Resident R702 to not have been checked for bowel/bladder incontinence from 6:00 AM to 10:30 AM, when the CNA was approached by the surveyor. The DON stated

they have a meeting scheduled with the aides next week to discuss further education and expectations moving forward. No further explanation or documentation was provided by the end of the survey.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Regency at Troy

2685 West Maple Road Troy, MI 48084

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This citation pertains to intake #2605657Based on observation, interview and record review, the facility failed to ensure medications were stored appropriately in one medication cart of one medication carts reviewed for medication storage and labeling. Findings include:On 9/25/25 a concern submitted to the State Agency was reviewed which alleged facility staff were not storing medications properly. On 9/25/25 at approximately 11:22 a.m., a medication cart that was located on the second floor next to room [ROOM NUMBER] was observed unlocked and unattended by any Nursing staff. The medication cart top drawer was observed to contain multiple unidentified pills stored in an uncovered and unlabeled plastic cup as well as a second uncovered plastic cup full of a white powdery substance. No resident name was attached to the pills or powder that identified what the pills/powder were or what resident they belonged to. On 9/25/25 at approximately 11:25 a.m., Nurse Manager B (NM B) was observed coming out of a resident's room and was queried regarding the unlocked medication cart. Nurse B indicated they had forgotten to lock it when

they left. NM B was queried regarding the uncovered plastic cups containing powder and multiple pills inside their unlocked medication cart and they reported they were saving them for later because a resident was not able to take them when they had brought them in for administration. NM B was queried if that was

the normal process for storage of medication after not being able to be administered and they indicated it was not. On 9/25/25 a facility document titled Medication Administration was reviewed and revealed the following: Resident medications are administered in an accurate, safe, timely, and sanitary manner .2. Make sure that the medication cart is locked at all times when it is not in use or not within your constant vision.

Store the locked medication cart in the appropriate storage area between med passes .10. Follow the medication/pharmacy guidelines for storage A second facility document titled Medication Management was reviewed and revealed the following: Medications are stored, dispensed and destroyed in a manner to ensure safety and conformance with state and federal laws .1. Non- controlled medications prepared, but not administered, are disposed of according to state law/guidelines. Controlled medications prepared, but not administered must be witnessed and countersigned by a licensed nurse on the controlled drug inventory sheet .

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Regency at Troy

2685 West Maple Road Troy, MI 48084

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 0809

forget to provide the room change notification slip to the kitchen.

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

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Regency at Troy

2685 West Maple Road Troy, MI 48084

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

infectious agents for which additional precautions are needed to prevent infection transmission .A review of

the Centers for Disease Control website revealed the following regarding enhanced barrier precautions: Enhanced Barrier Precautions are an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs) in nursing homes. Enhanced Barrier Precautions involve gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO as well as those at increased risk of MDRO acquisition (e.g., residents with wounds or indwelling medical devices) .

Event ID:

Facility ID:

If continuation sheet