Mission Point Nursing & Physical Rehabilitation Ce

In the surveyor’s words

From the most serious findings on record at Mission Point Nursing & Physical Rehabilitation Ce, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Feb 5, 2024

  This Citation pertains to Intake Number MI00142207. Based on interview and record review, the facility failed to protect Resident #103's (R103) right to be free from neglect, which resulted in R103's physical deterioration and subsequent death. Immediate Jeopardy: The Immediate Jeopardy began on [DATE] when Resident #103 (R103) was admitted to the facility from the hospital for short-term rehab following a left arm fracture and a Urinary Tract Infection (UTI). An admission nursing assessment identified only a pressure injury on the right heel. […]

• Immediate jeopardy, isolatedF689Sep 8, 2023

  This citation pertains to intake # MI00139197, MI000136833, MI000137737. This citation has multiple Deficient Practice Statements (DPS), A & B. DPS A Based on interview and record review, the facility failed to acknowledge, identify, and provide adequate supervision to prevent an elopement and ensure the safety of 1 resident (Resident #66), reviewed for risk of elopement, placing all residents with a history of wandering and/or elopement behavior at risk of serious harm and/or death. This deficient practice resulted in an Immediate Jeopardy beginning on 8/29/23 at 2:40 PM, when R66, a known elopement risk, eloped from the facility after Receptionist F allowed him to leave the building unattended. […]

• Immediate jeopardy, isolatedF678Apr 18, 2023

  This citation pertains to intake #: MI00135410 Based on interview and record review, the facility failed to ensure staff initiated timely and appropriate Cardiopulmonary Resuscitation (CPR) per standards of care, federal regulation, and their own facility policy and procedures, resulting in an immediate jeopardy when 1 resident (Resident #103), who was a full code (desired full life saving measures), was found unresponsive in respiratory distress and subsequently cardiac arrest. Licensed nursing staff did not know how to appropriately respond causing a delay in rescue attempts and R103's death. […]

• Immediate jeopardy, isolatedF684Apr 18, 2023

  This citation pertains to intake #: MI00135410 Based on observation, interview, and record review the facility failed to 1.) stock or re-stock medication carts with necessary medications for residents and 2.) ensure that all on-duty nurses had access to the pyxis (medication dispensing system) in the event of a medical emergency resulting in an immediate jeopardy when, beginning on [DATE], the facility licensed nurses did not have access to and were unable to administer emergency/life-saving medication to a resident in hypoglycemic crisis (R102) resulting in her death. […]

• Actual harm, isolatedF684Feb 5, 2024

  This Citation is related to Intake Number MI00141306 Based on observation, interview, and record review, the facility failed to provide quality care to 3 of 5 residents (Resident #17, Resident #101, and Resident #126) reviewed for quality of care, resulting in untreated sepsis and septic shock for R17. Findings include: Resident #17 (R17) Review of an admission record showed R17 was a [AGE] year old female, originally admitted to the facility on [DATE], with pertinent diagnoses of Huntington's disease, diabetes mellitus, gastrostomy with tube feed for hydration and nutrition. R17 was completely dependent on staff for all activities of daily living. Review of a Nursing Progress Note (NPN) for R17 dated 09/05/23 revealed .resident with dyspnea (difficulty breathing). […]