Father Murray, A Villa Center

In the surveyor’s words

From the most serious findings on record at Father Murray, A Villa Center, in the surveyor’s own words.

• Actual harm, isolatedF600Feb 29, 2024

  This citation pertains to Intake Number MI00142477 Based on observation, interview, and record review, the facility failed to protect the resident's right to be free from verbal and physical abuse by staff, affecting one resident (Resident #135) of five residents reviewed for abuse, resulting in R135 experiencing physical and psychosocial harm as determined by the reasonable person concept. Findings include: Resident #135 (R135): An allegation of staff-to-resident abuse involving Staff N and R135 was submitted to the state agency. On 2/27/24 at 3:49 PM, R135 was observed lying in bed. R135's room was observed to be located near the locked visitor bathrooms and near the front lobby. […]

• Actual harm, isolatedF691Mar 28, 2023

  This citation pertains to Intake MI00132939. Based on interview and record review, the facility failed to adequately assess, monitor and document provided care to an ileostomy (last part of small intestine has an opening through the abdominal wall to collect waste) and surrounding skin for one resident (R700) of one residents reviewed for ostomy care, resulting in unmet care needs, and inadequate assessment and treatment of skin breakdown resulting in hospitalization . Findings include: A complaint filed to the State Agency was reviewed and included the following: [R700] .has a Colostomy (ileostomy) Bag .[and] was brought into the emergency room (ER) today via ambulance for Medical Device Malfunction. There was not a malfunction, [R700] has a colostomy (ileostomy) with no bag on it. […]

• Actual harm, isolatedF600Nov 9, 2021

  This citation pertains to Intake MI 832. Based on interview and record review, the facility failed to implement and operationalize policies and procedures to protect one Resident (R936) from willful Staff to Resident sexual aggressive behavior, resulting in a vulnerable resident being subjected to sexual suggestive discussions, exposure of private area, the potential of degradation, and feeling of disappointment. Findings include: Review of submitted Facility Reported Incident (FRI) intake documentation revealed the following: Investigation Summary Resident alleges that (Staff K) employee had been making sexual remarks to (R936) during (their) shift. This employee (Staff K) is an afternoon floor care service worker. […]

• Actual harm, isolatedF600Apr 13, 2021

  This citation pertains to intakes MI 218 and MI 221. Based on interview and record review, the facility failed to maintain an environment free of abuse for two sampled residents, R#803 and R#804, of six reviewed for abuse, resulting in 1) R#804 being pushed by R#805, which resulted in a [CONDITION(S)], pain, hospitalization , and surgical repair and 2) R#803 being hit in the face by R#801, which resulted in a cut on the lip. Findings include: R#804 and R#805 On 4/12/21 at 9:43 AM, a request for R#804's acute care hospital records from November 2020 were requested. […]

• Actual harm, isolatedF689Feb 3, 2021

  This citation pertains to intake # MI 393. Based on interview and record review, the facility failed to develop and implement new interventions following falls for two of three residents (#702 and #704) reviewed for falls, resulting in repeated falls, pain, fractures and hospitalization . Findings include: Resident #702 A record review of the Progress Notes revealed the following for Resident #702: 9/17/2020 09:43 (AM) .Resident was found sitting on the floor with legs extended in front of (them) at beginning of the shift . 10/7/2020 04:35 (AM) .Writer returned from break and made aware by covering nurse that resident was observed on floor at around 0420 (AM) in sitting position with legs spread out next to (their) bed. […]