Warren Woods Health And Rehabilitation Center

F-F504 was admitted to the facility on [DATE REDACTED] with diagnosis of cervical disc disorder with myelopathy, carcinoma of the prostate, repeated falls, and adult failure to thrive. Resident R504's Brief Interview for Mental Status (BIMS) Score dated 1/15/2025 assessment was 6/15. A score of 6 indicates severe cognitive impairment. A care plan for mood difficulties and adjustment concerns related to psychotropic medication use was created on 1/10/25. Resident R504 had been identified with Activities of Daily Living (ADL) Care deficit and initiated a plan of care, which included a Bowel and Bladder incontinence on 1/7/25.

Resident R505

Record review revealed Resident R505 was admitted to the facility on [DATE REDACTED] with a diagnosis of Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left non-dominant side, unsteadiness on feet, reduced mobility, and dysphagia in addition to other diagnoses. Resident R505's ADL Self Care Performance requiring extensive assistance was created on 6/27/24 with Bowel and Bladder Incontinence Care.

An interview with the Activities Director was conducted on 4/8/25 at 12:15 PM. The Activities Director confirmed witnessing Resident R505 touching another resident's chest in the dining room. The Activities Director described, There were 3 to 4 residents in the dining room, but no staff was there to supervise them. I just stepped out of my office when I saw the incident.

Social Services Director SSD B was interviewed on 4/8/25 and confirmed Resident R504 was right next to Resident R505 when Resident R505 inappropriately touched Resident R504.

Certified Nurse Aide CNA J was interviewed on 4/8/25 at 3:30 PM. CNA J was assigned to Resident R505 and revealed that Resident R505 was heard exhibiting sexual behaviors before the incident occurred. Resident R505

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 4 235259 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 235259 B. Wing 04/08/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mission Point Nsg & Phy Rehab Ctr of Warren 11525 E Ten Mile Rd Warren, MI 48089

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 0600 was at the B-wing. CNA J stated, I did not see it for myself but heard staff talk about it. Resident R505 looks at you in

an inappropriate way and was warned by other staff to be careful when providing care for Resident R505. Level of Harm - Minimal harm or potential for actual harm The Director of Nursing (DON) on 4/8/25 at 4:20 PM stated no staff reported any inappropriate or sexual behavior observed for Resident R505. We separated both and updated their care plan. There are many activities staff, Residents Affected - Few and they should not have been left unsupervised.

The facility's Policy for Abuse and Neglect was reviewed on 4/8/25 at noon.

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FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 4 235259