Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around December 2026
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 Medilodge Of Livingston during CMS and state inspections, most recent first.
A resident with opioid dependence, depression, and homelessness did not receive recommended psychotherapy or addiction specialist follow-up, despite psychiatric evaluations and care plans indicating these services were needed. Facility staff were unaware of the recommendations, and documentation showed no evidence of ongoing behavioral health interventions beyond initial assessments.
A resident with intact cognition and significant medical conditions did not consistently receive scheduled showers as outlined in their care plan, with multiple missed showers and inadequate documentation of refusals or preferences. The resident reported irregular showering and had submitted a grievance regarding this issue, which had not yet been resolved.
A resident with complex respiratory needs did not receive timely respiratory assessments upon admission and before and after breathing treatments. Staff documented outdated vital signs instead of current measurements, and progress notes contained inaccuracies regarding ventilator settings. The respiratory director confirmed that assessments should have been performed at the time of treatment, but staff used previous vital signs due to staffing shortages.
A resident with a history of atrial fibrillation and diabetes fell from a mechanical lift due to a worn-out sling, resulting in fractures and surgery. The sling appeared old and worn, and staff were unclear about who was responsible for checking its integrity. The facility's policy required routine checks, but there was a lack of clarity and enforcement regarding final inspections.
The facility did not consistently implement physician-approved pharmacist recommendations for residents' medication regimens. For example, a resident's digoxin administration lacked required pulse monitoring, and another resident's medication diagnosis was not updated as recommended. Additionally, multiple requests for blood tests were delayed, and results were not shared with the pharmacist. These actions violated the facility's policy on addressing medication regimen review irregularities.
The facility failed to ensure proper medication storage and labeling in two medication carts. Observations revealed loose medications not contained in bottles or blister packs, and an open albuterol inhaler without a date. Another cart had an opened nitroglycerin bottle without resident identifiers and loose medications, including Xanax. The DON and ADON confirmed the facility's procedure required dating inhalers and acknowledged the inappropriate storage and labeling.
A facility failed to maintain professional standards in medication administration when an LPN did not document the administration of Oxycodone to a resident in the narcotic log, resulting in a discrepancy between the documented and actual count of tablets. The LPN acknowledged the oversight, which violated the facility's medication administration policy.
A resident with a history of falling, TBI, and dementia experienced multiple falls due to inadequate supervision and ineffective interventions. Despite being at high risk, the facility failed to consistently implement measures like visual checks and supervision during meals. The DON acknowledged the lack of documentation and the need for more effective strategies.
A resident with severe cognitive impairment and chronic conditions was observed receiving the wrong enteral nutrition formula and infusion rate, contrary to the physician's order. The resident was supposed to receive Osmolite 1.5 at 70ml/hour for 18 hours a day, but was instead given Jevity 1.5 at 60ml/hour. This discrepancy was confirmed by the ADON upon reviewing the EMR, highlighting a failure to adhere to the facility's policy on feeding tubes.
The facility experienced inadequate staffing levels, particularly during weekends and night shifts over the summer, leading to unmet care needs for residents. Residents and CNAs reported delayed responses to call lights and insufficient supervision for fall-risk residents. A resident noted that staffing was typically low, with only one CNA for 31 patients, but observed increased staff presence during the survey visit.
A resident with a history of falling, traumatic brain injury, and dementia was administered PRN Ativan for anxiety multiple times without documented non-pharmacological interventions being attempted first. The facility's policy requires such interventions to be attempted and documented, but this was not done, leading to a deficiency.
Failure to Provide Behavioral Health Services for Resident with Depression and Substance Dependence
Penalty
Summary
A deficiency was identified when the facility failed to provide appropriate behavioral health services to a resident with a history of opioid dependence, depression, and homelessness. The resident was admitted for long-term care due to the need for 24-hour assistance with activities of daily living, skilled nursing care, and medication management. Upon admission and during subsequent evaluations, the resident reported ongoing moderate depression, anxiety, and insomnia, which were attributed to his life circumstances, including homelessness and health issues. Psychiatric evaluations recommended increasing antidepressant medication and specifically advised psychotherapy for ongoing depression, with the resident agreeing to the plan of care. Despite these recommendations, the facility did not arrange for the resident to receive psychotherapy or ensure follow-up with an addiction specialist as documented in the medical record. Interviews with the Social Work Assistant revealed that they were unaware of the recommendation for psychotherapy and had no documentation that such services were provided. Additionally, there was no evidence that the resident was seen by an addiction specialist, despite multiple notes indicating referrals were needed for addiction medicine and withdrawal management. Facility policy required that residents exhibiting behavioral health needs be reviewed by a Behavior Management team and that individualized plans of care, including non-pharmacological interventions, be implemented. However, the resident was only seen by behavioral health providers on two occasions, and no ongoing psychotherapy or addiction specialist services were documented. This lack of follow-through on recommended behavioral health interventions constituted the deficiency.
Failure to Provide Scheduled Showers for Resident Requiring ADL Assistance
Penalty
Summary
A deficiency was identified when a resident, who was alert and cognitively intact with a BIMS score of 14/15 and diagnoses including type II diabetes and acute respiratory failure, did not consistently receive scheduled showers as required by their care plan. The resident was observed in bed and reported that while they had received a shower the previous day, they were not regularly provided showers and often only received bed baths. Review of the resident's clinical and task records over a 30-day period showed multiple missed scheduled showers, with some days where neither a shower nor a bed bath was documented, and no notes indicating refusals or preferences for bed baths on those dates. Further investigation included interviews with the CNA assigned to the resident, who confirmed that showers are generally given twice per week and stated that they provide showers as preferred by residents. However, documentation did not support that the resident's preferences were honored or that refusals were recorded. Additionally, a grievance regarding missed showers was submitted by the resident, but it had not yet been fully addressed at the time of the survey.
Failure to Perform Timely Respiratory Assessments and Accurate Documentation
Penalty
Summary
The facility failed to perform appropriate respiratory assessments for a resident who was dependent on a mechanical ventilator and had multiple complex diagnoses, including chronic respiratory failure with hypoxia, COPD, a history of lung cancer, and end stage renal disease. Upon the resident's readmission, documentation errors were noted, including inaccurate progress notes regarding ventilator settings and the use of outdated vital signs from a previous hospitalization. The respiratory evaluation on the day of readmission recorded vital signs from a prior date, rather than current measurements. Additionally, during the administration of breathing treatments, the respiratory therapist documented pre- and post-treatment vital signs that were several hours old and not reflective of the resident's current status at the time of treatment. The facility's respiratory director confirmed that vital signs should be taken at the time of assessment and treatment, but acknowledged that staff sometimes used previous nursing vital signs due to staffing shortages. The care plan for the resident included monitoring for effectiveness of medications and reporting adverse effects, but the required assessments were not performed as ordered.
Failure to Assess Sling Integrity Leads to Resident Fall
Penalty
Summary
The facility failed to assess the integrity of a mechanical transfer sling, resulting in an avoidable fall for a resident who required emergent transfer to a higher level of care and surgery for fractures. The resident, who was cognitively intact and had a medical history including atrial fibrillation, chronic osteomyelitis, and diabetes, required assistance with activities of daily living due to muscle weakness, reduced mobility, and morbid obesity. The incident occurred when the resident was being transferred using a mechanical lift, and the sling ripped, causing the resident to fall and sustain injuries. Interviews and record reviews revealed that the sling used during the transfer appeared worn out, and the fabric sewn to the strap looked old and worn. The CNAs involved in the transfer noted the sling's compromised condition and intended to discard it after the transfer. However, the sling failed during the transfer, leading to the resident's fall. The CNAs and other staff members were unable to confirm who was responsible for checking the integrity of the slings before use. The facility's policy required routine checks and maintenance of mechanical lift equipment by nursing and maintenance staff to ensure equipment remained in good working order. However, there was a lack of clarity among staff regarding who was responsible for the final inspection of the slings. The Director of Nursing confirmed that the responsibility lay with the staff placing residents into the sling, but this was not effectively communicated or enforced, contributing to the incident.
Failure to Implement Pharmacist Recommendations
Penalty
Summary
The facility failed to ensure that physician-approved recommendations from the pharmacist were consistently implemented for several residents. For one resident, the pharmacist recommended daily apical pulse readings before administering digoxin, with specific parameters to hold the medication if the pulse was below 60. Although the physician agreed with this recommendation, it was not reflected in the resident's medication order or administration record. Another resident's medication regimen review showed a recommendation from the pharmacist that lacked a documented physician response, and the Director of Nursing (DON) was unable to provide this documentation before the survey exit. Additionally, a resident with multiple health conditions, including end-stage renal disease and major depressive disorder, had a pharmacist's recommendation to update the diagnosis associated with an antipsychotic medication, which was not implemented. The pharmacist also made multiple requests for specific blood tests over several months, which were not conducted until much later, and the results were not uploaded for the pharmacist's review. The facility's policy requires that irregularities reported by the pharmacist be documented and acted upon, but this was not consistently followed, leading to deficiencies in medication management.
Medication Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to ensure proper medication storage and labeling in two of the three medication carts reviewed. During an observation of Medication Cart C Hall #2, it was found that loose medications were not contained in bottles or blister packs. The loose medications included a white round pill, an orange oval pill, a tan oval pill, and half a tablet of a purple pill, which was identified by the LPN as midodrine. Additionally, an open albuterol inhaler was found without a date, which the LPN acknowledged should have been dated per protocol. In another observation of Medication Cart E 500 Hall, a bottle of opened nitroglycerin was found without any resident identifiers, and the LPN was unable to specify which resident it belonged to. The cart also contained loose medications, including a round white pill, a quarter white pill, and half a tan pill. The narcotic box contained half a tab of a peach-colored pill, identified by the LPN as Xanax. Furthermore, three open boxes of albuterol inhalers were not dated, and the LPN was unclear about the facility's policy on dating inhalers. The DON and ADON confirmed that the facility's procedure required dating inhalers and acknowledged the inappropriate storage and labeling of medications.
Failure to Document Narcotic Administration
Penalty
Summary
The facility failed to ensure that nursing staff maintained professional standards and practices in medication administration for a resident. During an observation, an LPN was seen preparing Oxycodone, a narcotic for pain, for a resident. Upon reviewing the narcotic log, it was found that there was a discrepancy between the documented number of Oxycodone tablets and the actual count in the blister pack. The LPN admitted that the medication had been administered earlier but was not documented in the narcotic log, which is a requirement according to the facility's medication administration policy.
Failure to Prevent Recurring Falls for High-Risk Resident
Penalty
Summary
The facility failed to implement effective interventions to prevent recurring falls for a resident identified as R22, who was at high risk for falls due to a history of falling, traumatic brain injury, and dementia. Observations and interviews revealed that the facility had insufficient staffing levels to adequately supervise residents at risk of falling, as noted by a nurse who expressed the need for more CNAs to ensure proper supervision. Despite the installation of anti-tippers on R22's wheelchair, the resident experienced multiple falls, indicating that the interventions in place were not sufficient. R22's medical records showed several falls occurring shortly after their admission, with incidents documented on multiple dates. The falls were often associated with activities such as eating or moving around the facility, and the resident was noted to have poor self-awareness and safety awareness. Despite these incidents, the facility's interventions, such as visual checks every 15 minutes and supervision while eating, were either not consistently implemented or not effective in preventing further falls. Additionally, a medication review was noted as an intervention, but no changes were made to the resident's medications. The Director of Nursing acknowledged the lack of documentation for the visual checks and the failure to continue certain interventions after reviewing the falls. The DON also recognized that the intervention of supervision while eating was not followed during a fall that occurred while the resident was eating in their room. The facility's policy stated that each resident would be assessed for fall risks and receive care accordingly, but the repeated falls of R22 highlighted a deficiency in the implementation of this policy.
Failure to Follow Physician's Order for Enteral Nutrition
Penalty
Summary
The facility failed to adhere to the physician's order for enteral nutrition for a resident who was observed receiving the incorrect formula and infusion rate. The resident, who had been admitted with diagnoses including anoxic brain damage and chronic respiratory failure, was observed on multiple occasions receiving Jevity 1.5 at 60ml per hour with 55ml per hour autoflush, instead of the prescribed Osmolite 1.5 at 70ml per hour for 18 hours a day. This discrepancy was confirmed by the Assistant Director of Nursing (ADON) upon reviewing the electronic medical record (EMR). The resident's medical record indicated a comprehensive care plan that included the administration of enteral nutrition per physician orders, initiated due to risks related to altered nutritional status, aspiration, and swallowing problems. Despite these documented needs, the facility did not follow the prescribed enteral nutrition orders, as evidenced by the incorrect formula and rate being administered. The facility's policy on feeding tubes emphasized the necessity of using them according to physician orders, which was not followed in this instance.
Inadequate Staffing Levels in LTC Facility
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of its residents, as evidenced by observations, interviews, and record reviews. During the fiscal quarter three, the facility had excessively low weekend staffing numbers, resulting in a one-star staffing rating. Residents reported that staffing during the night over the summer months was inadequate, leading to delayed responses to call lights and uncollected meal trays. The resident council minutes from April to June 2024 also documented complaints about untimely bed-making, uncollected trays, and grumpy aides on weekends. Certified Nursing Assistants (CNAs) confirmed that staffing levels were insufficient, particularly during the summer months, with only two aides assigned to a unit where three were needed to supervise fall-risk residents adequately. Resident 10, who is cognitively intact with a BIMS score of 15/15, expressed concerns about the lack of staff, noting that typically there is only one CNA for 31 patients. On the day of the survey, R10 observed an unusual increase in staff presence, which they attributed to the surveyors' visit. R10 felt that the usual staffing levels were inadequate and unfair to residents, describing the situation as an insult. The staffing coordinator acknowledged the staffing issues, citing the simultaneous resignation of several full-time CNAs as a contributing factor to the short-staffing during that period.
Failure to Implement Non-Pharmacological Interventions Before PRN Psychotropic Medication
Penalty
Summary
The facility failed to ensure non-pharmacological interventions were attempted prior to the administration of PRN psychotropic medication for a resident with a history of falling, traumatic brain injury, and dementia. The resident, who required assistance with most activities of daily living and had memory impairments, was prescribed Ativan as needed for anxiety. The medication was administered multiple times over a period of days without documented attempts of non-pharmacological interventions beforehand. The Director of Nursing acknowledged that nurses should attempt and document non-pharmacological interventions before administering PRN Ativan, but there was no documentation of such interventions in the resident's progress notes. The facility's policy requires that psychotropic drugs are only given when necessary and beneficial, with non-pharmacological approaches attempted and documented prior to administration. However, this policy was not followed in the case of the resident, leading to the deficiency.
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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 Howell
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The Willows At Howell | 1.5 mi | — | 2 | 0 |
| Medilodge Of Howell | 3 mi | — | 19 | 0 |
| Wellbridge Of Brighton | 7.8 mi | — | 6 | 0 |
| Wellbridge Of Pinckney | 11.7 mi | — | 1 | 0 |
| Caretel Inns Of Brighton | 12.1 mi | — | 6 | 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.