Regency At Whitmore Lake

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

have anything more to do with that incident.During an observation and interview on 08/27/2025 at 3:35 PM, Resident R1 was observed leaving his room and stopped in the hallway. Resident R1 stated Resident R2 continued to walk down his hall which was hall 200 and not the hall Resident R2 resided on. Resident R1 stated Resident R2 continues to attempt to always sit be him during activities. Resident R1 stated it pissed him off, he got mad about it, and it upset him. Resident R1 state Resident R2 goes into activities and other events to be near him, and he didn't like it. Resident R1 stated again, it really pissed him off.During an interview on 08/28/2025 at 10:05 AM, Licensed Nursing Home Administrator (LNA) A stated that after the incident on 3/30/2025, Resident R2 was transfer to the 100 hall and out of the memory care unit. LNA A stated Resident R2 had kissed Resident R1 and Resident R3 outside of the memory unit. LNA A stated that Resident R2 is now more involved in activities and eating in the dining room. LNA A added if nursing feels Resident R2 needed one on one supervision,

they would pull a CNA off the floor from providing care to be with Resident R2 however, LNA A did not state what would cause nursing to feel Resident R2 needed the one-on-one supervision. LNA A stated she didn't see Resident R2 kissing Resident R1 and Resident R3 as inappropriate behavior, because Resident R2 did not latch onto him but more of an affectionate thing.This writer asked LNA A if other residents and staff were interviewed that live or work on that hall.

LNA A stated no. LNA A stated she did not interview the residents that live on that hall, she would have had to interview all residents because Resident R2 walks throughout the whole facility. Writer asked LNA A if the staff working in that area on the dates that this took place were interviewed, LNA A stated no.This writer asked LNA A if IDT meetings were held and documented any follow up from these incidents. LNA A stated they discussed it during IDT meetings, but it is not documented anywhere.LNA A stated that I & A is a risk management report where the nurses document the event that accrued, notifies the LNA, family, DON, provider, describes the event, immediate action to take place, removed Resident R2 from the memory care unit, SW H to follow up. Looked for any predisposition factors, SW H wrote what they did, referred to psychiatric services, SW H became the key person to oversee this. Could have had a telehealth visit made with the provider, LNA A and DON B discuss what should be done until they write up the 5-day report. LNA A stated

they look at QA based on the audits, education to staff if there was a break in the process. LNA A stated

they would put in new interventions if the current ones didn't work. LNA A stated they didn't have anything else to add. Stated they went back to the care plan and added one-on-one supervision based off her behavior. Resident R2 is more involved with activities. Asked why she didn't change or add new interventions, because they were already doing everything, they said they were already in place and because it was working.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Regency at Whitmore Lake

8633 N Main Street Whitmore Lake, MI 48189

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

separated them and told the nurses on their units, DON B and LNA A. Receptionist I stated she assisted

the DON B with filling out the form and DON B told her that she would submit the form to the state.

Receptionist I stated she didn't have anything more to do with that incident.During an observation and

interview on 08/27/2025 at 3:35 PM, Resident R1 was observed leaving his room and stopped in the hallway. Resident R1 stated Resident R2 continued to walk down his hall which was hall 200 and not the hall Resident R2 resided on. Resident R1 stated Resident R2 continues to attempt to always sit be him during activities. Resident R1 stated it pissed him off, he got mad about it, and it upset him. Resident R1 state Resident R2 goes into activities and other events to be near him, and he didn't like it. Resident R1 stated again, it really pissed him off. During an interview on 08/28/2025 at 10:05 AM, Licensed Nursing Home Administrator (LNA) A stated that after the incident on 3/30/2025, Resident R2 was transfer to the 100 hall and out of the memory care unit. LNA A stated Resident R2 had kissed Resident R1 and Resident R3 outside of the memory unit. LNA A stated that Resident R2 is now more involved in activities and eating in the dining room. LNA A added if nursing feels Resident R2 needed one on one supervision, they would pull a CNA off the floor from providing care to be with Resident R2 however, LNA A did not state what would cause nursing to feel Resident R2 needed the one-on-one supervision.

LNA A stated she didn't see Resident R2 kissing Resident R1 and Resident R3 as inappropriate behavior, because Resident R2 did not latch onto him but more of an affectionate thing.This writer asked LNA A if other residents and staff were interviewed that live or work on that hall. LNA A stated no. LNA A stated she did not interview the residents that live on that hall, she would have had to interview all residents because Resident R2 walks throughout the whole facility. Writer asked LNA A if the staff working in that area on the dates that this took place were interviewed, LNA A stated no.This writer asked LNA A if IDT meetings were held and documented any follow up from these incidents. LNA A stated they discussed it during IDT meetings, but it is not documented anywhere.LNA A stated that I & A is a risk management report where the nurses document

the event that accrued, notifies the LNA, family, DON, provider, describes the event, immediate action to take place, removed Resident R2 from the memory care unit, SW H to follow up. Looked for any predisposition factors, SW H wrote what they did, referred to psychiatric services, SW H became the key person to oversee this. Could have had a telehealth visit made with the provider, LNA A and DON B discuss what should be done until they write up the 5-day report. LNA A stated they look at QA based on the audits, education to staff if there was a break in the process. LNA A stated they would put in new interventions if

the current ones didn't work. LNA A stated they didn't have anything else to add. Stated they went back to

the care plan and added one-on-one supervision based off her behavior. Resident R2 is more involved with activities.

Asked why she didn't change or add new interventions, because they were already doing everything, they said they were already in place and because it was working.

Event ID:

Facility ID:

If continuation sheet