Medilodge of Holland

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY This citation pertains to intake #2664534Based on interview and record review, the facility failed to ensure medications were available and given within physician ordered parameters for two of three resident's (Resident 100 and Resident 109) reviewed for professional standards. Findings:Resident #100 (R100)Review of an admission Record revealed R100 was a [AGE] year-old male, admitted to the facility on [DATE], with pertinent diagnosis of Parkinson's Disease and Dementia. Review of an Electronic Medication Administration Record (Emar) dated August 2025 revealed a medication order for R100 to take Namenda one 10 milligram (mg) tablet twice daily for Dementia. Documentation for administration of this medication to R100 reflected that the medication was not available starting the evening of August 12th and continued to be unavailable until the morning of August 22nd. Further review of the documentation revealed that a physician was not notified that the medication was unavailable for R100 and that the resident…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY This citation pertains to intake # 2664534Based on observation, interview, and record review, the facility failed to secure prescription medications in two of four treatment carts and one of four medication carts, and for three of four residents (Resident R100, Resident R109, Resident 108) reviewed for medication storage. Findings:During an observation on 12/26/2025 at 12:43 PM, the treatment cart on the 400 hall was not locked. Upon review, the drawers contained prescription ointments, bandages and scissors. During an observation on 12/30/25 at 7:15 AM, the 200-hall treatment cart was not locked and contained prescription medications and treatments. During an observation on 12/30/25 at 9:02 AM, the 100-hall medication cart was unlocked and unattended by a nurse. During an observation on 12/26/25 at 3:30 PM a small plastic cup of prescription medications sat on top of the 100-hall medication cart and was not attended by a nurse. Resident #100 (R100)Review of an admission Record revealed R100 was a [AGE] year-old…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to follow infection control practices for enhanced barrier precautions and medication administration for four of six residents (Resident #100, Resident #104, Resident #105, and Resident #106) reviewed for infection control. Findings:Resident #100 (R100)Review of an admission Record reflected R100 admitted to the facility 2/20/2025 with diagnoses that included neuromuscular dysfunction of the bladder. Review of a Care Plan initiated 2/20/2025, revised 10/14/2025 reflected that R100 required enhanced barrier precautions related to Foley catheter placement. During an observation on 12/26/25 at 12:40 PM, there was no signage on R100's room that indicated he required Enhanced Barrier Precautions (EBP) nor any Personal Protective Equipment (PPE) for staff to utilize when providing close contact care. Resident #104 (R104)Review of an admission Record reflected R104 admitted to the facility on [DATE] with diagnoses that included neuromuscular…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure call lights were within reach of residents for one of three residents (Resident#107) reviewed for call light placement. Findings:Resident #107 (R107)Review of an admission Record reflected R107 originally admitted to the facility on [DATE] with diagnoses that included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (left side paralysis following a stroke). Review of a Minimum Data Set (MDS) assessment dated [DATE] reflected R107 had moderate cognitive impairment as evidenced by a Brief Interview for Mental Status (BIMS) score of 10/15. The assessment reflected R107 needed setup or clean-up assistance to eat and with oral hygiene and was dependent on staff for toileting hygiene, shower/bathe self, lower body dressing and putting on/taking off footwear. During an observation and interview on 12/26/2025 at 12:27 PM, R107 was observed in bed, the touch pad call light was out of reach. R107…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY This citation has two deficient practice statements. DPS A Based on observation, interview, and record review, the facility failed to follow standards of practice when caring for peripherally inserted central catheter (PICC) lines for two of two resident's (Resident #230 and Resident #224) reviewed. Findings: Resident #230 (R230) Review of an admission Record revealed R230 was a [AGE] year old Spanish speaking male, admitted to the facility on [DATE], with pertinent diagnoses of recent surgical removal of the right great toe due to osteomyelitis and the need for IV (intravenous) antibiotics. During an observation on 05/06/25 at 11:42 AM, Registered Nurse (RN) D entered R230's room to hang antibiotics and administer them through the PICC line. The PICC line did not have an end cap on it. RN D correctly cleaned the end of the PICC line with an alcohol wipe and then laid the end of the PICC line on R230's blanket. RN D prepared the antibiotic and connected the tubing to the end of the PICC line without cleaning the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to position two of two resident's (Resident #37 and Resident #49) in a manner to reduce the likelihood of choking or aspirating. Findings: Resident #37 (R37) Review of an admission Record revealed R37 was a [AGE] year-old female, last admitted to the facility on [DATE], with pertinent diagnoses of dementia, epilepsy, cognitive communication deficit, generalized muscle weakness, and the need for assistance with personal care. R37 utilized a tube feed to assist with nutrition and hydration and required assistance from 1 staff person for bed mobility and eating. During an observation on 05/08/25 at 9:03 AM, R37 (a) laid in bed awake with the head of the bed at 14 degrees, (b) held an emesis basin with both hands and it sat on her chest touching her chin and bottom lip, (c) had a white cloth that sat under the basin and was saturated with emesis. R37 stated I'm sick a lot. R37 had 2 glasses of nectar thick fluids bedside and within reach. During…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure proper accountability and storage of controlled substances and medications resulting in controlled substance verifying counts not conducted on the Lodge Hall, an unaccounted for controlled substance for one resident (R25), and an outdated and in use medication with a shortened shelf life after opening, and the potential for controlled substance diversion and administration of outdated medication with decreased efficacy. Findings: On 5/9/23 at approximately 11:12 AM an observation and interview were conducted with Licensed Practical Nurse (LPN) E at the Lodge Hall medication cart. It was also observed that the Electronic Medical Record (EMR) displayed a list of seven resident names in a bright pink color. LPN E reported that the resident names in the bright pink color displayed by the EMR system indicated the medications were late for administration. LPN E reported that although the system indicated the medications were late the facility had a liberalized med pass providing a widened administration time…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY This citation refers to intake M100134981. Based on interview and record review, the facility failed to report and thoroughly investigate an allegation of valued ring missing for 1 (Resident #423), resulting in the State Agency not being notified of a potential misappropriation of property. Findings include: Resident #423 Review of a Face Sheet revealed R423 originally admitted to the facility on [DATE] with pertinent diagnoses of hemiplegia and hemiparesis (one sided weakness), vascular dementia, and a right above the knee amputation. In an interview on 5/10/23 at 10:35 AM, R423's wife (Family Member) FM M reported the resident had a gold ring with a diamond on it that was tight on his finger that was missing since around September of last year. FM M reported she told the Nursing Home Administrator (NHA) and the Social Worker (SW). In an interview on 5/11/23 at 8:09 AM, the NHA reported he did not report the ring was missing for R423 because they were doing Caring Partner rounds and was not updated that the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to assess and implement care and services for 1 (Resident #53), reviewed for range of motion, resulting in a resident not receiving appropriate care for contractures and the potential for worsening. Findings include: Resident #53 (R53) Review of a Face Sheet revealed R53 originally admitted to the facility on [DATE] with pertinent diagnoses of hemiplegia and hemiparesis (one sided weakness), epilepsy, and a left femur fracture. Review of the Minimum Data Set (MDS) dated [DATE] revealed R53 is cognitively intact and requires extensive assistance of one staff for bed mobility and transfers did not occur. She has limited range of motion on one side of her upper and lower extremities, and no behaviors of rejecting care. During an observation and an interview on 5/9/23 at 2:19 PM, R53 was in bed and reported she is weak on the left side of her body and complained she did get therapy off and on. Her left hand is contracted with her fingers folded…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure medications were administered in accordance with Doctor's Orders and Manufacturer's recommendations for two Residents (R62 and R41) resulting in a medication error rate of greater than five percent, ineffective and reduced efficacy of the medications administered, and the potential for all facility residents to receive medication incorrectly. R62 Review of the Electronic Medical Record (EMR) reflected R62 originally admitted to the facility 1/22/2022 with pertinent diagnoses that included End Stage Renal Disease (ESRD) and Dependence on Renal Dialysis. On 5/11/2023 at 8:52 AM a medication administration observation was conducted with Licensed Practical Nurse (LPN) E and R62 in his room. LPN E was observed administering oral medication to R62. The medications included sevelamer carbonate 800 mg, three tabs with the direction for the medications to be administered with meals. In an interview conducted 5/11/2023 at 10:55 AM R62 reported that he ate breakfast approximately 8:00 AM. Review of the EMR…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to track the vaccination status and provide the pneumococcal vaccine for 2 of 5 residents (R24 and R223) reviewed, resulting in a delay in R24 and R223 receiving their requested pneumococcal vaccines. Findings include: R24 A review of R24's admission Record, dated 5/11/23, revealed R24 was an [AGE] year-old resident admitted to the facility on [DATE]. In addition, Resident 24's admission Record revealed multiple diagnoses that included congestive heart failure, diabetes, and weakness. A review of R24's Minimum Data Set (MDS) (a tool used for assessing a resident's care needs), dated 3/14/23, revealed a Brief Interview for Mental Status (BIMS) (a scale used to determine a resident's cognitive status) score of 15 which revealed R24 was cognitively intact. A review of R24's Pneumococcal Vaccine Consent Form, dated 3/8/23, revealed R24 requested to be given the pneumococcal vaccine. A review of R24's facility immunization records revealed R24 had received the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.