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Citation history
Health deficiencies cited at Regency At Livonia during CMS and state inspections, most recent first.
Three residents had indwelling Foley catheters in place without documented clinical indications such as urinary retention, obstruction, or neurogenic bladder, despite the facility’s policy requiring clear justification and ongoing review of catheter necessity. One cognitively intact resident reported catheter problems, stated staff refused to call 911 when she wanted hospital transfer, and had multiple UTIs treated with antibiotics while no genitourinary diagnosis was listed until the DON had urinary retention added on the day of the survey. Another resident with pressure ulcers and chronic foot ulcers had a Foley catheter from admission, a documented UTI with multiple organisms, and antibiotic treatment, but her diagnosis list contained no GU or wound-related diagnoses supporting catheter use, and a wound consult documented bowel and bladder incontinence without referencing a catheter as part of the wound plan. A third resident had a long-standing Foley, a culture-confirmed UTI with multiple organisms, and antibiotic therapy, yet no GU diagnosis supported catheter placement. The DON acknowledged that diagnoses justifying catheter use had been missed and were not present in the face sheet or diagnosis lists, and surveyors found that required documentation of indications for continued catheter use was lacking.
A resident who required staff assistance for ADLs did not receive scheduled showers as outlined in their care plan, with documentation showing only six showers in a 30-day period. The resident reported remaining in bed for extended periods and receiving showers less frequently than scheduled. Staff interviews confirmed that the resident was not assisted due to competing priorities, and the DON acknowledged inconsistencies in following the shower schedule.
A resident with a history of protein calorie malnutrition experienced significant weight loss due to the facility's failure to provide timely assessment and monitoring. Despite the care plan requiring 1:1 feeding assistance, the resident was observed alone with uneaten meals. The facility did not adhere to its policy for re-weighing residents after significant weight changes, leading to unmet nutritional needs.
The facility failed to maintain a clean and homelike environment in the common and rehabilitation areas. Observations included sticky floors, garbage, dirty ice machines, greasy popcorn machines, dusty baseboards, and unkempt windowsills with dead insects. The rehabilitation room and kitchen had debris, soiled equipment, and unclean surfaces. The Housekeeping Manager confirmed these findings, which contradict the facility's policy to promote a sanitary environment.
A resident with severe cognitive impairment and multiple diagnoses, including Cerebral Infarction and Hypertension, was found without an activities care plan or activity logs. The resident was observed alone in their room without stimulation, and the facility's NHA confirmed the absence of activity logs. The DON acknowledged issues with the Activities Director, and the facility's policy requiring an ongoing activity program was not followed.
A resident with a urinary tract infection was not administered their prescribed antibiotic, Cipro, upon readmission to the facility. The admission nurse failed to order the medication, resulting in the pharmacy not receiving the order. The resident, who was cognitively intact, expressed concern about not receiving the medication, which was confirmed by the Unit Manager and Director of Nursing. The facility's policy on verifying and communicating physician orders was not followed, leading to this deficiency.
A facility failed to provide and document activities for a severely cognitively impaired resident who required assistance for mobility. The resident, with diagnoses including cerebral infarction and muscle weakness, was repeatedly observed alone without activities or stimulation. Despite the facility's policy for individualized activity programs, no activity logs were available, and the NHA confirmed this deficiency, with the DON acknowledging issues with the Activities Director.
A facility failed to apply a resident's prescribed hand splint and elbow brace as per physician's orders and care plan. The resident, with a diagnosis of contracture, was observed without the brace over several days and reported it had not been applied for about a month. The therapy director found the braces in the resident's closet, and the MAR showed they were not documented as applied on specific dates.
A facility failed to properly store medications, as observed in a resident's room and two medication carts. A resident had an unidentified pill on their table, later identified as atorvastatin 20mg, which was not administered by the current nurse. Additionally, medication carts contained loose, unpackaged medications without patient identifiers. The DON acknowledged these storage issues, which violate the facility's policy.
A resident with vascular dementia exited a facility without staff knowledge, triggering a door alarm. The LPN on duty delayed calling a facility-wide elopement code, opting for a preliminary search instead. The resident was later found by police at a grocery store 0.8 miles away. The facility's policy required an immediate code search, which was not followed.
A resident with muscle weakness and end-stage renal disease did not receive timely Notice of Medicare Non-Coverage (NOMNC) from the facility, receiving it only a day before services were to end. This led to an appeal by the resident's family, which was successful due to the insufficient notice. Facility staff were unsure why the notice was delayed, and the facility's policy did not address timely delivery of NOMNCs.
A resident with multiple medical conditions, including quadriplegia, was left with feces in their pressure ulcers for approximately five hours due to a failure in timely care by the responsible nurse. The resident had Stage III pressure ulcers and deep tissue injuries, and the incident occurred after a shower when the wounds were left uncovered.
The facility failed to ensure catheter care orders were provided for a resident with an indwelling catheter, leading to a lack of documentation and care completion. The DON acknowledged the oversight, which was not in accordance with the facility's policy on physician orders.
Lack of Clinical Indication and Documentation for Indwelling Catheters Leading to Recurrent UTIs
Penalty
Summary
The deficiency involves the facility’s failure to ensure proper diagnosis or clinical indication to support the insertion and continued use of indwelling urinary catheters for three residents, as well as failures in documentation related to catheter necessity and associated UTIs. For one cognitively intact resident, an indwelling catheter was in place despite no documented diagnosis of urinary retention or other genitourinary condition in the diagnosis list. This resident had experienced multiple UTIs confirmed by laboratory results and had received several courses of antibiotics. During interview, the resident reported dissatisfaction with catheter-related care and stated that when she believed something was wrong with the catheter and wanted to go to the hospital, staff refused to call 911 and told her they needed physician permission for transfer; she reported that she had not seen the physician during her stay and felt her rights were violated. When questioned by surveyors, the DON initially acknowledged that urinary retention was not listed as a diagnosis, then left to review the record and shortly afterward had a new diagnosis of urinary retention entered into the electronic record on the same day as the survey, based on a prior urology consult. A second resident was observed with an indwelling catheter and had a history of UTI with multiple organisms, for which she had received antibiotic therapy. Her son, who was POA, reported that she had recently had a UTI from her catheter and was on antibiotics, and the resident expressed concern about delays in care and the risk of her wounds becoming infected if she remained soiled. Review of her clinical record showed no diagnosis supporting catheter placement, such as urinary retention, bladder obstruction, or neurologic bladder issues. The resident’s care plan documented an indwelling catheter and catheter care from admission, but there were no diagnoses of wounds or genitourinary conditions in the diagnosis list. The DON stated that the catheter was continued because of multiple wounds and that the resident was seen regularly by a wound consultant; however, the wound consult reviewed by surveyors listed multiple pressure ulcers and chronic foot ulcers and documented bowel and bladder incontinence, but did not mention an indwelling catheter as part of the wound treatment plan or as an intervention for wound prevention or healing. A third resident also had an indwelling catheter in place since admission, with no genitourinary diagnosis documented to support its use. This resident’s record showed a prior episode of flank pain and gross hematuria, with subsequent urinalysis and culture confirming a UTI with multiple organisms, followed by an order for antibiotic therapy. Despite this, there was no diagnosis in the record to justify the ongoing use of an indwelling catheter. During interview, the DON acknowledged that she could not justify the use of urinary catheters for these residents based on the face sheet and diagnosis pages and admitted that diagnoses for catheter use had been missed and were not previously entered. The facility’s own policy on indwelling urinary catheter care and management, which emphasizes that inappropriate or unnecessary catheter use can result in CAUTI and requires documentation of indications for continued catheter use, was not followed, as the records lacked documented indications for catheter placement and continuation for all three residents. Across all three residents, surveyors confirmed that each had experienced UTIs requiring antibiotic treatment while having indwelling catheters in place, yet their diagnosis lists did not contain conditions supporting catheter necessity. The DON later reported adding diagnoses for some residents based on prior consults and progress notes, but these were not present before the surveyor’s inquiry. The facility policy required review of the necessity of continued catheter use and documentation of indications, maintenance care, assessment findings, and teaching, but the survey findings showed that the indication for catheter use was either absent or only added retroactively, and that the residents’ records did not reflect a clear, clinically supported rationale for the presence of indwelling catheters.
Failure to Provide Scheduled Showers and ADL Assistance
Penalty
Summary
A deficiency was identified when a resident, who required staff assistance for activities of daily living (ADLs), did not receive scheduled showers as outlined in their care plan. Observation revealed the resident remained in bed, wearing a hospital gown, with significant facial hair growth, and reported not having been out of bed for the entire weekend. The resident stated that showers were received only about once per week, rather than the scheduled minimum of two times per week. Review of the resident's medical record confirmed the need for ADL assistance and documented only six showers over a 30-day period, which did not align with the facility's stated schedule. Interviews with staff indicated that the resident was not assisted out of bed due to staff being occupied with other residents, particularly those requiring dialysis. The CNA on duty reported not having time to assist the resident earlier in the day. The DON confirmed that the resident's shower schedule was not consistently followed, as evidenced by gaps in the shower documentation. Facility policy required residents to receive necessary assistance for grooming and hygiene, including scheduled showers, but this was not adhered to in the resident's case.
Failure to Monitor and Address Resident's Weight Loss
Penalty
Summary
The facility failed to ensure timely assessment and monitoring following an identified weight loss for a resident, resulting in weight loss and unmet nutritional needs. The resident, who had a history of protein calorie malnutrition and was dependent on assistance for eating, experienced a significant weight loss of 10 pounds in less than a month. Despite the care plan indicating the need for 1:1 feeding assistance and monitoring of significant weight changes, the resident was observed alone with uneaten meals on multiple occasions. The facility's policy required re-weights to be completed within 72 hours for significant weight changes, but this was not adhered to, as the re-weight was delayed. The resident's medical record indicated a weight of 112 pounds on admission, which dropped to 102 pounds within a short period, and further decreased to 96.2 pounds. The facility's dietician requested a re-weight to confirm the accuracy of the weight changes, but this was not conducted in a timely manner. The Director of Nursing acknowledged issues with weight monitoring and the facility's failure to complete weights per policy. The facility's Weight Management policy outlined specific procedures for monitoring and addressing weight changes, which were not followed, contributing to the deficiency.
Facility Fails to Maintain Cleanliness in Common and Rehabilitation Areas
Penalty
Summary
The facility failed to maintain a homelike environment in the residential common areas and rehabilitation area, as observed on December 18, 2024. The first and second floor dining and common areas were found with sticky matter on the floors, garbage on the ground, and dirty ice machines with white debris. Popcorn machines had greasy interiors with popcorn kernels adhered to the walls and basin. Baseboards were dusty and floors had dried spilled matter. Windowsills were dirty with dead insects, and the back door had insect webs and leaves. A dirty mop, dustpan, and broom were stored against the wall where residents were socializing. The first-floor dining room had damaged drywall with debris near food delivery carts. The carpet throughout the first floor appeared unvacuumed with debris in common areas and hallways. In the rehabilitation room, the access door to the outside had insect nests, webs, and dead insects. Debris was noted between the carpet and floor mat, and the baseboards had dust and debris. A soiled dustpan and broom were stored among rehabilitation equipment. The rehabilitation kitchen had a Geri chair with dried matter on it, and the countertops and stove had dried crumbs. The microwave was unkempt inside and out. The Housekeeping Manager acknowledged these findings during a tour, confirming the presence of dead insects and webs. The facility's housekeeping policy, dated February 2023, emphasizes promoting a sanitary environment, which was not upheld in these observations.
Failure to Implement Activities Care Plan for Resident
Penalty
Summary
The facility failed to initiate an activities care plan for a resident, identified as R94, who was observed multiple times alone in their room without any activities or stimulation. R94 was admitted with diagnoses including Cerebral Infarction, Hypertension, and Muscle Weakness, and was noted to be severely cognitively impaired, requiring assistance for bed mobility and transfers. Despite these needs, the facility did not have an activities care plan in place for R94, and no activity logs were available. The Nursing Home Administrator confirmed the absence of activity logs, and the Director of Nursing acknowledged issues with the Activities Director. The facility's policy mandates an ongoing activity program based on individual evaluations and care plans, which was not adhered to in this case.
Failure to Administer Prescribed Antibiotic
Penalty
Summary
The facility failed to ensure that medication was administered as ordered for a resident who was readmitted with a urinary tract infection. The resident, who was cognitively intact with a BIMS score of 15/15, expressed concern about not receiving their prescribed antibiotic, Cipro, since their readmission. The resident had been hospitalized for severe symptoms related to the infection and required surgical placement of a supra pubic catheter. Upon readmission, the admission nurse did not order the antibiotic, resulting in the pharmacy not receiving the order and the resident not receiving the necessary medication. The Unit Manager confirmed that the After Visit Summary indicated the need for Cipro to be started on the day of readmission, but the order was not transcribed. The Director of Nursing acknowledged that the medication was not transcribed upon readmission, and the resident should have started the antibiotic as ordered. The facility's policy requires physician orders to be verified and communicated to the pharmacy, which was not followed in this case, leading to the deficiency.
Failure to Provide Activities for a Cognitively Impaired Resident
Penalty
Summary
The facility failed to document and provide activities for a resident who was severely cognitively impaired and required assistance for bed mobility and transfers. The resident, who had diagnoses including cerebral infarction, hypertension, and muscle weakness, was observed multiple times alone in their room without any activities or stimulation. Despite the facility's policy to provide an ongoing activity program based on individual evaluations and care plans, there were no activity logs available for this resident. The Nursing Home Administrator confirmed the absence of activity logs, and the Director of Nursing acknowledged issues with the Activities Director.
Failure to Apply Prescribed Braces for Resident
Penalty
Summary
The facility failed to ensure that a resident's hand splint and elbow brace were applied as per the physician's orders and the resident's care plan. The resident, who was observed multiple times over several days, was found without the prescribed brace on their contracted right arm and hand. The resident reported that the brace had not been applied for about a month. The therapy director later found the braces in the resident's closet, and it was noted that the restorative team was responsible for applying them. The resident's medical records indicated a diagnosis of contracture in the right elbow, and the care plan required the application of the hand splint and elbow brace for up to four hours as tolerated, alternating days. However, the Medication Administration Record (MAR) for December showed that the braces were not documented as applied on specific dates. The facility's policy on the Brace and Splint Program outlined the procedure for applying such devices, but it was not followed, leading to the deficiency.
Improper Medication Storage in Facility
Penalty
Summary
The facility failed to ensure proper storage of medications, as evidenced by observations of medication carts and a resident's room. During an observation, a resident was found with an unidentified pill on their overbed table. The resident was unsure of the medication's identity, and the assigned nurse confirmed that the medication had not been administered during their shift. The pill was later identified as atorvastatin 20mg, which was supposed to be administered at bedtime, suggesting a lapse in medication management and storage. Further observations revealed that two medication carts contained multiple loose medications without proper packaging or patient identifiers. Medications were found scattered in various drawers of the carts, including pills of different shapes and colors, some of which were broken or damaged. The Director of Nursing acknowledged that medications should not be stored in this manner, as per the facility's policy, which mandates that medications be stored in their original containers. This indicates a systemic issue with medication storage practices within the facility.
Delayed Elopement Code Response for Resident with Dementia
Penalty
Summary
The facility failed to initiate a facility-wide elopement code in a timely manner for a resident, identified as R902, who exited the facility without staff knowledge. On the morning of the incident, the resident, who had a history of vascular dementia with moderately impaired cognition, left the facility through the front door. The door alarm was triggered, but the staff did not immediately call the elopement code. Instead, the LPN on duty initially searched the premises and instructed a CNA to assist in the search before officially calling the code. The resident was found by the police at a grocery store approximately 0.8 miles away from the facility, near a busy intersection leading to the freeway. The resident explained that they left to handle personal business and did not inform the staff to avoid being persuaded to stay. The LPN admitted to hearing the alarm and conducting a preliminary search before realizing the resident was missing and calling the code search. The facility's policy required an immediate call for a code search when a resident was unaccounted for, which was not followed in this instance. The delay in initiating the code search and notifying the police contributed to the resident's unsupervised departure from the facility. The Director of Nursing confirmed that the LPN should have called the elopement code immediately to start a facility-wide search for the resident.
Failure to Provide Timely Notice of Medicare Non-Coverage
Penalty
Summary
The facility failed to provide a Notice of Medicare Non-Coverage (NOMNC) to a resident, identified as R700, in a timely manner. R700 was admitted with medical diagnoses of muscle weakness and end-stage renal disease and had an intact cognition as indicated by a Brief Interview for Mental Status score of 15/15. The NOMNC indicated that services were to end on May 3, 2024, but the notice was only signed and dated by R700 on May 2, 2024, providing less than the usual 48 hours of notice. This lack of timely notification led to an appeal by the resident's family, which was decided in the resident's favor due to the insufficient notice. Interviews with facility staff revealed uncertainty about the delay in providing the NOMNC. The Business Office Manager (BOM) stated that typically residents receive at least 48 hours of notice and speculated that the insurance company might have sent the NOMNC late. The MDS Registered Nurse (RN) confirmed that the resident did appeal but not in a timely manner, and the NOMNC was included in the appeal documentation. A review of the facility's policy on Medicare Notice of Non-Coverage did not address the timely delivery of NOMNCs, indicating a gap in the facility's procedures.
Failure to Provide Timely Pressure Ulcer Care
Penalty
Summary
The facility failed to provide appropriate care for pressure ulcers for a resident, identified as R702, who was admitted with multiple medical conditions including sepsis, quadriplegia, and neuromuscular dysfunction of the bladder. R702 was physically dependent for all activities of daily living and had Stage III pressure ulcers on the ischium and sacrum, as well as deep tissue injuries on the heels. During an observation, it was noted that R702's wound dressing was bunched and the wound was exposed with drainage on the brief. R702 reported that after a shower, the wounds were left uncovered, and they became incontinent of bowel, waiting approximately five hours for a nurse to provide care. The Wound Care Nurse (WCN) confirmed the resident's account and revealed that the responsible nurse was written up for the incident. The WCN explained that wound care is typically provided on specific days, and if a dressing becomes soiled, the CNA is supposed to notify the responsible nurse. However, on the day of the incident, the responsible nurse failed to provide timely care, resulting in the resident being left with feces in their wounds for an extended period.
Failure to Provide Catheter Care Orders
Penalty
Summary
The facility failed to ensure that catheter care orders were provided for a resident with an indwelling catheter. The resident, who had diagnoses including Multiple Sclerosis, Diabetes Mellitus, and Fibromyalgia, was readmitted to the facility following hospitalization due to a urinary tract infection attributed to the catheter. Upon readmission, no catheter care orders were documented for the period from the readmission date to the discharge date. Additionally, there were no documentation entries for catheter care in the resident's Kardex Task item during this period. The Director of Nursing (DON) acknowledged the absence of catheter care orders and reported that they were not obtained or entered into the electronic medical record (EMR). The DON explained that the catheter care Kardex item, which allows direct care staff to document care completion, was not renewed, resulting in no related checklist questions being available for staff. The facility's policy on physician orders states that orders must be documented and signed by the physician, and treatment must be in accordance with these orders. However, this protocol was not followed in this case, leading to the deficiency.
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Nursing homes near Livonia
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Majestic Care Of Livonia | 1.6 mi | — | 12 | 0 |
| Fountain Bleu Health And Rehabilitation Center | 1.7 mi | — | 11 | 0 |
| Livonia Woods Nursing And Rehabilitation | 2.1 mi | — | 0 | 0 |
| The Orchards At Redford | 2.7 mi | — | 5 | 0 |
| Four Chaplains Nursing Care Center | 2.7 mi | — | 8 | 0 |
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