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F0584
E

Failure to Maintain Safe, Clean, and Homelike Environment

Three Rivers, Michigan Survey Completed on 12-23-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide a safe, clean, and homelike environment for multiple residents, as evidenced by ongoing issues with hot water availability, unaddressed maintenance concerns, and unsanitary conditions. One male resident with Parkinson's disease, legal blindness, and dementia reported missing scheduled showers due to a lack of hot water, an issue persisting for months. Another female resident with cerebral palsy and muscle weakness also reported frequent hot water shortages during showers and was observed in a room with significant peeling paint and debris on the floor. A third male resident with diabetes and debility described his room as dirty upon admission, with chipped paint and a dirty pillow on the floor. Observations confirmed the presence of peeling paint, rusted door frames, chipped tiles, foul odors, and trash in common areas, as well as a damaged American flag and discarded gloves outside the facility. Staff interviews corroborated the residents' complaints, with an LPN acknowledging recent hot water issues in the shower room and the Maintenance Director stating that staff were instructed to let the water run to warm up. Despite these instructions, residents continued to experience discomfort and dissatisfaction with their living conditions, including missed showers and exposure to unclean and deteriorating environments.

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