Not rated by CMS — ratings are suppressed for new or low-volume facilities.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Fisher Senior Care And Rehabilitation during CMS and state inspections, most recent first.
The facility failed to ensure a clean and homelike environment, as observed with unlabeled personal items and improper storage practices. A resident's TED hose lacked identification and documentation, while another resident's denture cup was stored under a towel dispenser. Additionally, a partially used juice bottle was left unrefrigerated. Two residents shared a room with unlabeled urinals, increasing the risk of cross-contamination.
A facility experienced a medication error rate of 7.69% due to an LPN failing to prime insulin pens before administration to three residents. The Director of Nursing acknowledged the policy's lack of specific instructions on priming, and the LPN was unaware of the requirement, leading to incorrect insulin dosages.
The facility failed to update care plans for two residents, leading to potential unmet needs. One resident experienced significant weight loss not reflected in their care plan, and their catheter care plan was outdated. Another resident's advance directive care plan did not match their DNR status. Staff responsible for updates acknowledged the discrepancies.
A resident with a history of cataracts and diabetes did not receive necessary vision care follow-up due to missed appointments and lack of documentation. The facility failed to implement the optometrist's recommendations for eye drops, and staff were unable to account for the resident's absence during a scheduled eye care visit. The Director of Nursing acknowledged the oversight, and the facility did not provide a vision care policy upon request.
A facility failed to conduct a scheduled 72-hour care conference for a resident with multiple diagnoses, including pneumonia and chronic kidney disease. The resident, who was cognitively intact, and their family were not informed about the conference, which was intended to discuss care plans and needs. The social worker could not explain why the conference was not held, and no record of the meeting was found in the electronic medical record.
Failure to Maintain a Clean and Homelike Environment
Penalty
Summary
The facility failed to maintain a clean and homelike environment for several residents, leading to potential health risks. Resident #28 had a pair of TED hose in a shared bathroom without any identification, and there was no order or care plan for their use. The Director of Nursing confirmed the lack of documentation and identification for the TED hose. Resident #37 had a denture cup placed under a towel dispenser, risking contamination from water drips. Additionally, a partially used bottle of cranberry juice was found at the bedside without a date of opening or refrigeration, contrary to facility policy as confirmed by the Culinary Specialist. Residents #100 and #101 shared a room where personal items like urinals were not labeled with resident identification, posing a risk of cross-contamination. The Infection Control Preventionist acknowledged the lack of labeling and improper storage of personal items, such as the denture cup under the towel dispenser. These observations highlight the facility's failure to ensure personal items are properly labeled and stored, increasing the potential for infection and foodborne illness among residents.
Medication Administration Errors Due to Lack of Insulin Pen Priming
Penalty
Summary
The facility failed to ensure accurate medication administration, resulting in a medication error rate of 7.69%, which exceeds the acceptable threshold of 5%. This deficiency was identified during the observation of medication administration for three residents. The Licensed Practical Nurse (LPN) 'C' was observed administering medications to these residents without priming the insulin pens as required. Specifically, LPN 'C' administered insulin to residents R25, R4, and R14 without priming the insulin pens, which is a necessary step to ensure the correct dosage is delivered. During interviews, the Director of Nursing (DON) acknowledged that the facility's policy does not specify the amount of insulin to prime, but stated that the manufacturer's recommendation is typically followed, which involves priming with 2 units. LPN 'C' admitted to being unaware of the need to prime the insulin pens and mentioned that they were informed by other staff members about the priming requirement. The facility's policy on injectable medication administration, revised in January 2018, was reviewed and found to lack specific instructions on priming insulin pens, contributing to the medication administration errors observed.
Failure to Update Care Plans for Two Residents
Penalty
Summary
The facility failed to revise care plans for two residents, resulting in missing updates and potential unmet needs. Resident #19, who has severe cognitive impairment, experienced significant weight loss of 25.8 pounds (18%) over 30 days, which was not reflected in the nutrition care plan until much later. The Certified Dietary Manager acknowledged responsibility for updating the care plan but could not explain the delay. Additionally, the care plan for Resident #19's indwelling catheter was outdated, listing incorrect catheter specifications, which was confirmed by the Director of Nursing. Resident #39, also with severe cognitive impairment, had a discrepancy between their advance directive care plan and the physician's order for a do not resuscitate (DNR) status. The care plan incorrectly indicated that the resident was a full code, despite signed DNR documents. The social worker responsible for updating the care plan confirmed the mismatch between the care plan and the physician's order. The facility's policy requires ongoing assessments and timely revisions of care plans as residents' conditions change, which was not adhered to in these cases.
Failure to Provide Vision Care Follow-Up
Penalty
Summary
The facility failed to ensure that a resident received necessary vision services and follow-up care, resulting in untreated or unidentified vision issues. The resident, who had a history of cataracts, diabetes, and dry eyes, expressed concerns about his deteriorating vision and the need to see an eye doctor. Despite recommendations from an optometrist for regular follow-ups and specific eye care treatments, the facility did not document or implement these recommendations effectively. The resident's medical records indicated a missed eye care appointment due to the resident being unavailable, with no documentation explaining the absence. Additionally, the resident was not seen during a subsequent visit by the eye care group, and there was no clear reason provided for this oversight. The facility's staff, including the social worker designee and scheduler, were unable to account for the resident's whereabouts during the missed appointment and did not ensure the resident was available for the next scheduled visit. Furthermore, the facility did not follow through with the optometrist's recommendations for artificial tears, as there were no orders for the eye drops in the resident's medical records. The Director of Nursing acknowledged the lack of documentation and follow-up on the optometrist's recommendations, indicating a systemic issue in ensuring residents receive necessary vision care. The facility also failed to provide a policy for vision care upon request, highlighting a gap in their procedural documentation.
Missed 72-Hour Care Conference for Resident
Penalty
Summary
The facility failed to conduct a scheduled 72-hour care conference for a resident, resulting in a lack of communication and information for both the resident and their family. The resident, who was cognitively intact with a BIMS score of 15, was admitted with diagnoses including pneumonia, atrial fibrillation, chronic kidney disease, and a malignant neoplasm of the bladder. The care conference was intended to discuss the admission process, medications, dietary needs, activities, therapy plans, and home care needs. However, the conference was not held as planned, and the family, who was prepared to join by phone, was not contacted by the facility. Interviews with the social worker revealed that the care conference was scheduled for the day the resident passed away, but there was no explanation provided for why it was not conducted. The facility's policy requires the social services director or designee to contact the resident's family and maintain records of such notices, including the date, time, and method of contact. A review of the care conference calendar confirmed the scheduled meeting, but no record of the conference being completed was found in the electronic medical record.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Mayville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Tuscola County Medical Care Facility | 11.1 mi | — | 11 | 0 |
| Marlette Community Hospital Ltcu | 14.4 mi | — | 0 | 0 |
| Medilodge Of Frankenmuth | 18.9 mi | — | 1 | 0 |
| Wellspring Lutheran Services | 19.1 mi | — | 0 | 0 |
| Lapeer County Medical Care Facility | 19.5 mi | — | 15 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.