Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Durand Senior Care And Rehab Center during CMS and state inspections, most recent first.
A resident with insulin-dependent diabetes experienced a significant decline in condition, including elevated blood sugar levels and gastrointestinal symptoms, without timely notification to the physician. The facility failed to administer insulin as per the resident's previous regimen, leading to diabetic ketoacidosis and subsequent hospitalization. The resident passed away shortly after due to the acute condition.
The facility failed to provide adequate supervision and timely root cause analysis of fall incidents for three residents, leading to significant injuries. One resident re-fractured a hip after an unwitnessed fall, another suffered facial injuries due to a fall, and a third sustained a hip fracture and subdural hematoma. The facility's documentation was inconsistent, and interventions for high fall risk residents were insufficient.
The facility failed to maintain adequate staffing levels, resulting in multiple resident falls and injuries. A male resident with a history of falls was left unattended, leading to a re-fracture of his femur. A female resident with dementia suffered facial injuries from an unwitnessed fall, and another male resident experienced multiple falls, including a significant incident resulting in a hip fracture. Long call light response times further highlighted staffing issues.
The facility failed to maintain dignity for four residents during a dining observation. Staff members engaged in personal conversations while mechanically feeding residents, ignoring their needs and failing to engage them. Additionally, an MDS Nurse was observed yelling out to staff in the dining room, contributing to the lack of respect for the residents.
The facility failed to develop and implement comprehensive care plans for two residents, leading to potential unmet care needs. One resident did not receive required TED hose, and another had no documented care restrictions for a dialysis access port, causing staff confusion.
A resident with severe cognitive impairment experienced a delay in starting antibiotic treatment for MRSA. The wound culture results were available on 4/27/24, but the treatment did not begin until 4/29/24. The delay was due to inadequate communication and notification processes within the facility.
The facility failed to accurately assess, monitor, treat, and prevent pressure ulcers for three residents, leading to significant health deterioration. One resident's wound worsened, resulting in septic shock and death, while another's wound was misidentified and inadequately treated. A third resident developed a facility-acquired stage 2 pressure ulcer that was not properly documented or communicated to the physician.
A resident with Multiple Sclerosis and periods of confusion fell out of his wheelchair and sustained head injuries while alone near a local store. Despite multiple reports from bystanders, the facility staff did not verify the resident's condition or provide immediate assistance, assuming he was on a Leave of Absence (LOA). The resident was eventually helped by strangers and returned to the facility, where his injuries were assessed.
Failure to Notify Physician of Resident's Change in Condition
Penalty
Summary
The facility failed to provide timely notification to the physician for a resident who experienced a significant change in condition, resulting in a delay in medical treatment for diabetic ketoacidosis. The resident, a 93-year-old female with a history of insulin-dependent diabetes mellitus, was admitted to the facility for rehabilitation following a fall that resulted in multiple pelvic fractures. Upon admission, there was a lack of proper documentation and administration of insulin, despite the resident's known diabetes condition and previous insulin regimen. The resident's condition began to decline on February 14, 2025, with symptoms including nausea, vomiting, diarrhea, and elevated blood sugar levels. Despite these symptoms and blood sugar readings consistently above 250, with several readings over 300, there was no evidence that the physician was notified of the resident's change in condition until February 16, 2025. Even then, the notification was limited to the elevated blood sugar level, without mention of the resident's poor intake and gastrointestinal symptoms. The facility's failure to notify the physician in a timely manner contributed to the resident's deterioration, culminating in a hospital readmission on February 17, 2025, for diabetic ketoacidosis. The hospital records indicated that the resident's insulin regimen had been discontinued at the facility, which, combined with the stress of illness, led to the acute condition. The resident's condition worsened, and she passed away on February 19, 2025, despite life-saving efforts.
Inadequate Supervision and Fall Prevention in LTC Facility
Penalty
Summary
The facility failed to provide adequate supervision and timely root cause analysis of fall incidents for three residents, leading to significant injuries. One resident, a male with a history of hip surgery, peripheral vascular disease, and diabetes, experienced multiple falls, including an unwitnessed fall in the bathroom that resulted in a re-fractured hip. Despite being instructed to use the call light for assistance, the resident attempted to self-transfer, leading to the fall. The facility's documentation and witness statements were inconsistent, and the resident's high fall risk was not adequately addressed. Another resident, a female with dementia and on blood thinners, suffered an unwitnessed fall resulting in facial injuries. The facility was unable to determine how the fall occurred or how long the resident was on the floor before being found. The resident had a history of falls, and interventions such as non-slip footwear and gripper strips were not confirmed to be in place at the time of the fall. The facility's fall risk assessment noted the resident's poor cognition and safety awareness, yet the supervision and interventions were insufficient to prevent the fall. A third resident, a male with dementia and significant cognitive impairment, fell in the hallway, resulting in a hip fracture and subdural hematoma. The fall was unwitnessed, and the resident was found by a visitor. The resident was wearing hipsters and non-slip footwear, but the facility failed to provide adequate supervision and assistance, given the resident's impaired memory and gait imbalance. The facility's documentation indicated a lack of consistent monitoring and intervention for residents at high risk of falls.
Inadequate Staffing Leads to Multiple Resident Falls and Injuries
Penalty
Summary
The facility failed to maintain sufficient nursing staff levels to meet the needs of residents, resulting in several incidents of inadequate supervision and care. One resident, a male with a history of falls and a recent hip surgery, experienced an unwitnessed fall in the bathroom shortly after being readmitted to the facility. Despite being a high fall risk, he was left unattended by CNAs who were unaware of his fall risk status. This led to a re-fracture of his left femur, requiring extensive surgery and ultimately resulting in his admission to hospice care. Another resident, a female with dementia and a history of falls, suffered an unwitnessed fall resulting in significant facial injuries. The facility was unable to provide details on how the fall occurred or how long she was on the floor before being found. The resident was found with facial bruising and an open area above her left eye, and she reported slipping out of her wheelchair while wearing non-grip socks, indicating a lack of appropriate safety measures. A third resident, a male with dementia, experienced multiple falls, including a significant incident where he was found on the floor with a hip fracture, compression fracture, and subdural hematoma. Despite being a known fall risk, he was left to ambulate without assistance, leading to his injuries. The facility's call light response times were also noted to be excessively long, with residents waiting over 30 minutes for assistance, further highlighting the staffing inadequacies.
Failure to Maintain Resident Dignity During Dining
Penalty
Summary
The facility failed to maintain dignity for four residents during a dining observation in the 500 hall dining room. Specifically, two staff members, a Registered Nurse/Clinical Care Coordinator (RN/CCC) and a Life Enrichment Director (LED), were observed engaging in personal conversations while mechanically feeding residents. They did not attempt to engage the residents in conversation or address their needs, except for one instance where the RN/CCC asked a resident if they wanted dessert. The staff discussed personal topics such as vacation plans, food preferences, and family activities, ignoring the residents for 21 minutes. Additionally, a Minimum Data Set (MDS) Nurse was observed yelling out to staff in the dining room, further contributing to the lack of dignity and respect for the residents. The residents involved included a female resident with Parkinson's disease, anxiety, and respiratory failure, who had adequate hearing and clear speech but scored 8 out of 15 on the Brief Interview for Mental Status (BIMS). Another resident, a female with dementia, scored 00 on the BIMS, indicating severe cognitive impairment. A third resident also had severe cognitive impairment, scoring 00 on the BIMS. The staff's failure to engage these residents in conversation and the MDS Nurse's disruptive behavior in the dining room led to a decrease in the residents' self-worth and loss of dignity.
Failure to Implement Comprehensive Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive care plans for two residents, resulting in potential unmet care needs. Resident #7, who was admitted with diagnoses including chronic kidney disease and hypertension, had a physician's order for TED hose to be placed in the morning and removed at bedtime. Despite this order, observations and interviews revealed that the resident was not wearing the TED hose on multiple occasions, and staff were unclear about whose responsibility it was to ensure the TED hose were placed. The Treatment Administration Record (TAR) inaccurately reflected that the TED hose had been administered, and there was no documentation of refusal by the resident. Resident #10, who had diagnoses including diabetes and end-stage renal disease, required dialysis and had a vascular access port in his left arm. The medical record and care plans did not reflect any care restrictions for his left arm, which is critical to avoid complications. Interviews with staff revealed that they were unsure about the location of the dialysis access port and did not have clear instructions in the Kardex to avoid taking blood pressure on the left arm. This lack of documentation and clarity among staff could lead to improper care. Both cases highlight a failure in communication and documentation within the facility, leading to potential risks for the residents. The staff's lack of awareness and the absence of clear instructions in the care plans and Kardex contributed to the deficiencies observed by the surveyors.
Delay in Antibiotic Treatment for MRSA
Penalty
Summary
The facility failed to ensure timely antibiotic treatment for a resident diagnosed with Methicillin-resistant Staphylococcus aureus (MRSA). The resident, who had severe cognitive impairment, was observed in various states of activity on 05/09/24. A wound culture collected on 4/23/24 revealed heavy growth of MRSA, with final results reported on 4/27/24. However, the antibiotic treatment was not started until 4/29/24, two days after the results were available. The delay in treatment was not documented or explained in the medical records, and the on-call provider was not notified of the results in a timely manner. Interviews with the nursing staff revealed that laboratory results were entered into the electronic medical record (EMR) by the laboratory and were supposed to be communicated to the physician. However, nurses did not receive alerts for available results and relied on shift reports to be informed of pending results. The Infection Preventionist acknowledged the delay in starting the antibiotic treatment and stated that the expectation was for the on-call provider to be notified of the results. The facility's process for handling laboratory results and notifying providers was found to be inadequate, leading to the delay in treatment for the resident with MRSA.
Failure to Provide Adequate Pressure Ulcer Care
Penalty
Summary
The facility failed to accurately assess, monitor, treat, and prevent the development of pressure ulcers for three residents, resulting in significant health deterioration. Resident #103 was admitted with a small wound on the coccyx area, which worsened significantly due to inadequate care, leading to septic shock and eventual death. The wound nurse did not complete certified wound training and there was a delay in treatment initiation. The facility's documentation and communication with the physician were inadequate, contributing to the resident's decline and subsequent hospitalization for septic shock and complications related to the coccyx wound. Resident #107 reported having a painful open area on the bottom, which was initially misidentified as moisture-associated dermatitis. The wound nurse's assessment was inconsistent, and the wound was not properly staged or treated, leading to further complications. The facility's failure to accurately document and communicate the resident's condition resulted in inadequate wound care and monitoring. Resident #109 developed a facility-acquired stage 2 pressure ulcer on the right hip. The facility's documentation did not reflect the presence of the pressure ulcer, and the wound was not followed up weekly as required. The wound nurse and other staff failed to notify the physician of the new or worsening wound, relying instead on standing orders. The resident's condition worsened due to the lack of proper assessment, monitoring, and timely intervention, highlighting significant deficiencies in the facility's wound care management and communication protocols.
Failure to Respond to Resident's Fall and Head Injury
Penalty
Summary
The facility failed to respond, assess, and render immediate aid in a timely manner for a resident who experienced a fall. The resident, a male with Multiple Sclerosis and periods of confusion, was observed by random strangers falling out of his wheelchair and bleeding from his head while alone near a local store. Despite multiple reports from bystanders to the facility's receptionist and staff, no immediate action was taken to assist the resident. The receptionist and LPN on duty did not verify the resident's condition or location, assuming he was on a Leave of Absence (LOA), which was not documented. The incident report indicated that the resident fell while navigating a hill, resulting in abrasions to his forehead, knee, and pinky knuckle. The resident was eventually helped by strangers back into his wheelchair and returned to the facility. Upon his return, the resident was assessed, and his injuries were documented. However, the facility staff did not take immediate action when informed of the resident's fall and head injury, relying on the assumption that he was on an LOA and thus not their responsibility. Interviews with the Unit Manager, Director of Nursing, and other staff revealed a lack of clarity and responsibility regarding the resident's safety during an LOA. The staff did not verify the resident's status or provide immediate assistance, even when informed of his injuries. The facility's lack of a clear policy on LOA and the staff's inaction contributed to the deficiency in providing timely and appropriate care to the resident.
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What surveyors actually found near you
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Durand
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Pleasant View Shiawassee County Medical Care Facil | 10.4 mi | ★★★★★ | 0 | 0 |
| Argentine Care Center | 11 mi | ★★★★★ | 6 | 0 |
| Memorial Healthcare Center | 11.8 mi | ★★★★★ | 1 | 0 |
| Villa At Beecher Place | 12 mi | ★★★★★ | 13 | 1 |
| Willowbrook Manor | 12 mi | ★★★★★ | 4 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.