Inspection Reports for Bickford of Saginaw Township
5275 Mackinaw Rd, Saginaw, MI 48603, United States, MI, 48603
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Inspection Report
Complaint Investigation
Capacity: 71
Deficiencies: 1
Jul 2, 2024
Visit Reason
The investigation was initiated due to a complaint alleging that residents were not receiving appropriate care, including inadequate cleaning, showering, changing, and hydration, and that food service sanitation standards were not being enforced.
Findings
The investigation found no violation regarding resident care, concluding that care provided in the memory care unit was adequate. However, a violation was established for food service sanitation due to the service cart being encrusted with food debris and not included in cleaning schedules.
Complaint Details
Complaint alleged residents were not receiving appropriate care including insufficient cleaning, showering, changing, and hydration, and that food service sanitation standards were not enforced. The care allegation was not substantiated; the food service sanitation allegation was substantiated.
Deficiencies (1)
| Description |
|---|
| Food service equipment and work surfaces were not maintained in a clean and sanitary condition, specifically the service cart shelving was encrusted with food debris. |
Report Facts
Capacity: 71
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Barbara P. Zabitz | Health Care Surveyor | Author of the Special Investigation Report |
| Melissa Kline | Administrator | Facility administrator mentioned as off-site during inspection |
| Krystyna Badoni | Authorized Representative | Facility authorized representative who reviewed findings |
Inspection Report
Complaint Investigation
Capacity: 71
Deficiencies: 2
Jun 10, 2024
Visit Reason
The investigation was initiated due to a complaint alleging that Resident A eloped from the facility on 12/4/22 and was found outside in a ditch, resulting in hospitalization.
Findings
The investigation confirmed that Resident A left the secured memory care unit without staff knowledge and was found outside the facility, placing the resident at significant risk of harm. The facility failed to adequately supervise Resident A and did not maintain proper incident reporting and corrective action documentation.
Complaint Details
The complaint alleged that Resident A eloped on 12/4/22, was found in a ditch outside the facility, and was hospitalized for several days. The violation was substantiated.
Deficiencies (2)
| Description |
|---|
| Facility staff failed to adequately supervise Resident A, who eloped from the secured memory care unit without staff knowledge. |
| The licensee failed to maintain records demonstrating incident reporting, analyses, outcomes, corrective action taken, and evaluation related to Resident A's elopement. |
Report Facts
Capacity: 71
Complaint Receipt Date: May 17, 2024
Investigation Initiation Date: May 20, 2024
Hospitalization Duration: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melissa Kline | Facility Administrator | Submitted Resident A's chart and staff statements during investigation |
| Krystyna Badoni | Authorized Representative | Involved in investigation and initial review of Resident A's elopement event |
Inspection Report
Renewal
Census: 40
Capacity: 71
Deficiencies: 10
Mar 1, 2024
Visit Reason
The inspection was conducted as a renewal licensing study to evaluate compliance with applicable rules and regulations for license renewal.
Findings
The facility was found to be non-compliant with multiple rules including failure to produce documentation for quarterly fire drills, incomplete resident service plans, lack of tuberculosis screening evidence for residents and employees, missing criminal background checks for several employees, absence of meal census records, failure to regulate water temperature, and inadequate food storage and labeling practices.
Deficiencies (10)
| Description |
|---|
| Facility unable to produce documentation pertaining to quarterly fire drills as required by fire safety rules. |
| Resident A had an assistive device loosely attached to bed posing entrapment risk; no instructions or training provided for device use or monitoring. |
| Facility unable to provide a completed service plan for Resident E. |
| Facility unable to provide evidence of initial tuberculosis screening for Residents B, C, D, and E. |
| Facility unable to provide evidence of completed tuberculosis screening results for Associates 1, 2, 4, 5, and 6. |
| Facility unable to provide criminal background information for Associates 2, 3, 4, 5, and 6. |
| Facility unable to provide a meal census record. |
| Facility unable to provide water temperature regulation tracking; responsible associate had not been checking temperatures due to lack of thermometer. |
| Several food items in kitchen refrigerator and cabinets lacked date labels; some food items stored inadequately (e.g., opened and unsealed cereal box). |
| No thermometer found in refrigerator located in Resident G’s room. |
Report Facts
Number of staff interviewed and/or observed: 10
Number of residents interviewed and/or observed: 40
Facility capacity: 71
Number of excluded employees followed up: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Melissa Kline | Administrator | Named in facility identifying information |
| Associate 7 | Reported on assistive device use and training related to Resident A | |
| Associate 8 | Responsible for water temperature checks; reported not checking due to lack of thermometer | |
| Associates 1, 2, 3, 4, 5, and 6 | Referenced in relation to missing tuberculosis screening and criminal background information |
Inspection Report
Complaint Investigation
Capacity: 71
Deficiencies: 2
Mar 1, 2024
Visit Reason
The inspection was conducted in response to a complaint alleging that memory care residents were not provided adequate meal portions.
Findings
The investigation found that the facility did not provide adequate meal portions to memory care residents for a period of time, and the kitchen staff failed to maintain meal census records. The facility was found not in compliance with nutritional and meal record regulations.
Complaint Details
Complaint received from adult protective services on 02/28/2024 alleging inadequate meal portions for memory care residents. APS denied the allegation for investigation due to lack of witness information. The complaint was substantiated by the investigation.
Deficiencies (2)
| Description |
|---|
| Memory care residents were not provided adequate meal portions. |
| Failure to maintain meal census records as required. |
Report Facts
Capacity: 71
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alana Brissett | Wellness Director | Interviewed regarding meal portion concerns and facility food service practices |
| Melissa Kline | Administrator | Named as facility administrator |
| Aaron Clum | Licensing Staff | Author of the inspection report |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Approved the inspection report |
Inspection Report
Complaint Investigation
Capacity: 71
Deficiencies: 1
Aug 1, 2023
Visit Reason
The investigation was initiated due to a complaint alleging inadequate protection of Resident A, specifically that the resident was not administered prescribed medications.
Findings
The investigation found that Resident A was admitted without signed physician orders, resulting in the resident not receiving prescribed medications for atrial fibrillation. Resident A went into cardiac arrest and was pronounced deceased. The facility did not provide adequate protection or ensure medication administration as required.
Complaint Details
Complaint was substantiated that Resident A was not administered prescribed medications, leading to inadequate protection. The violation was established.
Deficiencies (1)
| Description |
|---|
| Inadequate protection of Resident A. Resident not administered prescribed medications. |
Report Facts
Capacity: 71
Complaint Receipt Date: Aug 1, 2023
Inspection Report
Renewal
Deficiencies: 0
Mar 24, 2023
Visit Reason
The document serves as a notification that the Home for the Aged license for Saginaw Bickford Cottage has been renewed for a 12-month period effective March 24, 2023.
Findings
The license renewal confirms that the facility is authorized to operate for another year at the specified address. No deficiencies or inspection findings are detailed in the document.
Report Facts
License duration: 12
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Aaron Clum | Licensing Staff | Signatory of the license renewal notification |
Inspection Report
Complaint Investigation
Capacity: 55
Deficiencies: 2
Jan 12, 2023
Visit Reason
The inspection was conducted in response to a complaint alleging neglect of Resident A and lack of kitchen staff at the facility.
Findings
The investigation found no violation regarding neglect of Resident A or lack of kitchen staff. However, violations were established for failure to document and report an incident involving Resident A's injury and for allowing an employee to provide direct services before completion of a required criminal background check.
Complaint Details
The complaint alleged Resident A was neglected, including being dropped on wheelchair bars causing bruising, and that the facility lacked kitchen staff with caregivers preparing food. The neglect allegation was not substantiated. The kitchen staffing allegation was also not substantiated.
Deficiencies (2)
| Description |
|---|
| Failure to document and report an incident involving Resident A's injury as required by facility policy and regulations. |
| Employee #1 provided direct services to residents prior to completion of a required criminal background check. |
Report Facts
Capacity: 55
Complaint Receipt Date: Dec 7, 2022
Investigation Initiation Date: Dec 8, 2022
Inspection Date: Jan 12, 2023
Report Due Date: Feb 6, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| SueNae Blankenship | Administrator | Interviewed regarding allegations and facility operations |
| Jeremiah Johnson | Authorized Representative | Contacted for census and employee list; participated in exit conference |
| Jessica Rogers | Licensing Staff | Conducted inspection and authored report |
| Andrea L. Moore | Manager, Long-Term-Care State Licensing Section | Approved the report |
Inspection Report
Original Licensing
Capacity: 55
Deficiencies: 0
Jan 25, 2007
Visit Reason
The inspection was conducted as an original licensing study to determine compliance with applicable licensing statutes and administrative rules for Saginaw Bickford Cottage.
Findings
The facility was found to be in substantial compliance with all applicable rules and statutes. The report recommends issuance of a six-month non-renewable temporary license with a maximum capacity of 55 beds.
Report Facts
Maximum capacity: 55
Memory care unit beds: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lilly Anne | Licensing Staff | Author of the licensing study report and recommendation. |
| Betsy Montgomery | Area Manager | Approved the licensing study report. |
| Judy Swartzell | Authorized Representative of the applicant. | |
| Amy Reiher | Administrator | Administrator of the facility. |
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