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F0657
D

Failure to Timely Revise Care Plan for New Diabetic Foot Ulcer

Mt. Pleasant, Michigan Survey Completed on 02-11-2026

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 revise the comprehensive care plan and formulate goals and interventions after a resident developed a new open wound. The electronic medical record showed that the resident, admitted on 12/10/2024 with a diagnosis including Diabetes Mellitus, was found on 1/13/2026 at 4:55 PM to have a new in-house acquired diabetic foot ulcer on the left lateral mid-foot, which was measured and dressed. However, review of the resident’s care plan revealed that no nursing care plan addressing this new wound, including goals/benchmarks for care or nursing interventions, was developed until after surveyors initiated the survey on 2/9/2026. In an interview on 2/9/2026 at 3:32 PM, the Unit Manager confirmed that the care plan for the new wound was not initiated until that date.

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Long-term care team reviewing survey readiness and plan of correction

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