State of Michigan DEPARTMENT OF HUMAN SERVICES May 17 ...

On 05/09/2013, I conducted an on-site investigation at the facility and reviewed the
medication log(s) for Resident A. I also interviewed staff Billie Heft, staff Sarah
Bakri, and staff Rachel Alberda.
The medication log for Resident A indicates that all medications are to be passed
with applesauce to prevent Resident A from chewing medications and supplements.
Although Resident A is on a number of medications and supplements, there is
nothing currently prescribed that requires it be taken after or with a meal. The
medication log(s) stated that Resident A is to be prompted to use the bathroom after
each meal and/or as needed. The logs stated that during the night (3 rd shift),
Resident A is to be awakened and prompted to use the bathroom at midnight and 5
a.m. The medication log includes an order that indicates that if Resident A refuses
any meals, Resident A is to be given a Carnation Instant Breakfast. None was
documented as given by Ms. Hunter on 04/22/2013.
Staff Billie Heft stated that when she came in to take another resident to an
appointment on 04/22/2013, she did tell Ms. Hunter that sometimes Resident A likes
to sleep in and she allows Resident A to do so. Ms. Heft stated that she would
never let Resident A stay in bed all day, indicating that she would get Resident A up
by lunch time, at the latest. Ms. Heft communicated that belief that even though
there are no written instructions for staff to be more insistent with Resident A, it is
“common sense” to do so.
Staff Sarah Bakri described her interaction with Ms. Hunter at the beginning of the
3 rd shift on 04/22/2013 as Ms. Hunter had reported. Ms. Bakri stated that she did
find Resident A to be very wet and prompted Resident A to get up so that she could
be showered and her bed changed. Ms. Bakri stated that occasionally when
Resident A has an incident of incontinence, Resident A might urinate a great
quantity. Ms. Bakri stated that occasionally during the night when staff prompts
Resident A to get up to use the bathroom, Resident A will refuse so staff will come
back later and try again. Ms. Bakri stated that Resident A sometimes gets up in the
night on her own to use the bathroom or to indicate that her Depends is wet and
needs assistance to be changed. Ms. Bakri stated that while assisting Resident A
with her shower, she did not observe any redness, skin breakdown, sores, or related
issues to having been left in a wet Depends. Ms. Bakri stated that Resident A
appeared to be feeling fine but stated that Resident A was seen by her doctor the
following day and was diagnosed with a UTI.
Staff Rachel Alberda stated that she worked the 3 rd shift with Ms. Bakri on
04/22/2013. Ms. Alberda stated that she assisted Ms. Bakri in getting Resident A up
and changed her bedding while Ms. Bakri helped Resident A take a shower. Ms.
Alberda stated that Resident A got up at 5 a.m. and used the bathroom without
incident. Ms. Alberda stated that Resident A did not appear to be not feeling well as
if that is the case, Resident A will typically be up and pacing most of the night. Ms.
Alberda stated that if she couldn’t get Resident A up to use the bathroom at all, she
would have attempted to change Resident A’s Depends in bed, as needed. Ms.
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