Inspection Report
Renewal
Census: 31
Capacity: 80
Deficiencies: 5
Aug 9, 2024
Visit Reason
The inspection was conducted as a renewal licensing study for Addington Place of Northville to assess compliance with applicable administrative rules and public health code statutes.
Findings
The facility was found to be non-compliant with several administrative rules including incomplete criminal history checks for employees, delayed tuberculosis testing, medication administration documentation errors, and improper food storage and labeling in the kitchen. Repeat violations were noted for medication administration and kitchen/dietary requirements.
Deficiencies (5)
| Description |
|---|
| Employee A’s file lacked evidence of a state police criminal history review and eligibility notice. |
| Employees B, C, D, and E did not have initial tuberculosis testing completed within required timeframes. |
| Medication administration records showed missed doses and failure to properly document medication administration for Residents A and B. |
| Perishable food items in the walk-in freezer were improperly stored uncovered; fruit salad containers lacked preparation date labels. |
| A freezer in the 'Asbury' hall warming kitchen did not have a reliable thermometer. |
Report Facts
Number of staff interviewed and/or observed: 16
Number of residents interviewed and/or observed: 31
Facility capacity: 80
Date of on-site inspection: Aug 9, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maurizio Palombi | Administrator | Confirmed medication administration and documentation issues |
Inspection Report
Complaint Investigation
Capacity: 80
Deficiencies: 1
Mar 14, 2024
Visit Reason
The investigation was initiated due to a complaint alleging that a resident of concern (ROC) had an injury consistent with physical mistreatment or abuse.
Findings
The investigation found that the facility did not conduct a systematic investigation into the allegation of physical abuse as required by facility policy. A violation was established related to failure to properly investigate and document the incident involving bruising on the resident.
Complaint Details
The complaint alleged that the Resident of Concern had bruising consistent with physical mistreatment or abuse. The allegation was substantiated with a violation established. The resident's family reported the injury and expressed concerns about lack of communication and investigation by the facility.
Deficiencies (1)
| Description |
|---|
| Failure to conduct a systematic investigation into an allegation of physical abuse in accordance with the established procedure of the facility. |
Report Facts
Capacity: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maurizio Palombi | Administrator | Facility administrator interviewed during investigation and acknowledged failure to adhere to grievance policy |
| Barbara P. Zabitz | Health Care Surveyor | Author of the Special Investigation Report |
Inspection Report
Renewal
Deficiencies: 0
Aug 10, 2023
Visit Reason
The document serves as a renewal notification for the Home for the Aged license following an administrative review of licensing activity over the past year.
Findings
The facility was found to be in substantial compliance with the public health code and administrative rules regulating home for the aged facilities, resulting in the renewal of the license.
Inspection Report
Complaint Investigation
Capacity: 80
Deficiencies: 1
Jul 10, 2023
Visit Reason
The inspection was conducted due to a complaint alleging the facility failed to provide timely notification to the department regarding a change in administrator.
Findings
The investigation confirmed that the facility did not provide timely notification to the department about the change in administrator, with the previous administrator ceasing employment on 2023-04-04 and the new administrator starting on 2023-05-08 without prompt notification or required paperwork submitted.
Complaint Details
The complaint alleged the facility failed to provide timely notification to the department regarding a change in administrator. The violation was established based on evidence that the facility did not notify the department within the required timeframe.
Deficiencies (1)
| Description |
|---|
| The facility didn’t provide timely notification to the department regarding a change in administrator. |
Report Facts
Capacity: 80
Complaint Receipt Date: Jul 9, 2023
Investigation Initiation Date: Jul 10, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maurizio Palombi | Administrator | Named as the facility administrator in identifying information |
| Stephen Levy | Authorized Representative | Named as the authorized representative in identifying information |
Inspection Report
Complaint Investigation
Capacity: 80
Deficiencies: 2
Aug 22, 2022
Visit Reason
The inspection was conducted in response to a complaint alleging multiple concerns including medication administration errors, cleanliness issues, lack of posted menus, and insufficient supplies at Addington Place of Northville.
Findings
The investigation substantiated that Resident A had not always received medications as prescribed and that weekly menus were not posted. Other allegations such as cleanliness, accommodation of resident requests, supply availability, COVID PPE supply, service plan updates, and staffing levels were not substantiated.
Complaint Details
The complaint alleged Resident A did not receive prescribed medications including Metamucil, Miralax, and Prilosec; dining tables and Resident A's room were not cleaned; weekly menus were not posted; the facility did not accommodate Resident A's dietary requests; resident units lacked cleaning supplies; paper towels and soap were missing at the dining room sink; insufficient COVID PPE supplies; front entrance door was not always locked; Resident A's service plan was not updated; Resident A's hands were not washed before meals; briefs were not changed; ted hose stockings were not checked; and there was only one medication technician for multiple units.
Deficiencies (2)
| Description |
|---|
| Resident A had not received her medications as prescribed. |
| Weekly menus were not posted. |
Report Facts
Facility capacity: 80
Medication technician staffing dates: 11
PPE supplies count: 4000
PPE supplies count: 2000
PPE supplies count: 200
PPE supplies count: 48
PPE supplies count: 500
PPE supplies count: 110
PPE supplies count: 30
PPE supplies count: 50
PPE supplies count: 500
Isolation carts: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Tyler May | Administrator | Interviewed regarding medication administration, staffing, and facility operations |
| Stephen Levy | Authorized Representative | Recipient of report and exit conference via voicemail |
| Jessica Rogers | Licensing Staff | Author of the Special Investigation Report |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Approved the report |
Inspection Report
Original Licensing
Capacity: 80
Deficiencies: 0
Feb 14, 2022
Visit Reason
The document is an addendum to the original licensing study report reflecting a change in management company and a facility name change for Addington Place of Northville.
Findings
The management company will be changed to SLH HTI East Manager, LLC effective 3/1/2022, and the facility name change to Addington Place of Northville is effective 3/10/2022. The license status remains unchanged.
Report Facts
Facility capacity: 80
Management change effective date: Mar 1, 2022
Facility name change effective date: Mar 10, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Elizabeth Gregory-Weil | Licensing Staff | Author of the addendum and recommendation |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Manager approving the addendum |
| Stephen Levy | Authorized representative of the licensee | |
| Susan Rice | Vice President of Clinical Operations | Notified department of management company change |
Inspection Report
Original Licensing
Capacity: 80
Deficiencies: 0
Dec 1, 2020
Visit Reason
The document is an addendum to the Original Licensing Study Report reflecting a change in management company for the facility effective December 1, 2020.
Findings
The management agreement between the licensee and the new management company requires reasonable efforts to obtain and maintain all licenses and permits and to comply with facility licensing requirements. The recommendation is to keep the license status unchanged despite the management change.
Report Facts
Capacity: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sheri Emery | Authorized Representative | Submitted management agreement for review |
| Mike Weil | Chief Executive Officer | Submitted BCAL-1600 application information update form confirming management change |
| Andrea Krausmann | Licensing Staff | Author of the addendum report |
| Russell Misiak | Area Manager | Signed the addendum report |
Inspection Report
Original Licensing
Capacity: 80
Deficiencies: 0
Feb 9, 2016
Visit Reason
The inspection was conducted as part of the original licensing study for Addington Place to determine compliance with applicable licensing statutes and administrative rules.
Findings
The facility was found to be in substantial compliance with licensing statutes and administrative rules. A temporary license with a maximum capacity of 80 residents was recommended and issued.
Report Facts
Capacity: 80
License term: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sheri Emery | Administrator and Authorized Representative | Named as the administrator and authorized representative appointed by an officer of ARHC APNVLMI01 TRS, LLC. |
| Linda Denniston | Licensing Staff | Conducted the inspection and authored the report |
| Betsy Montgomery | Area Manager | Approved the licensing recommendation |
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