Citations in Michigan
Statistics, citations and compliance trends for long-term care facilities in Michigan.
Statistics for Michigan (Last 12 Months)
Financial Impact (Last 12 Months)
Latest citations in Michigan
A resident with Type I DM and hyperglycemia was admitted with discharge orders to continue insulin Lispro via a patient-supplied insulin pump, but the facility did not add BG monitoring when transcribing the orders. The resident later became clammy and unable to talk, had repeated HI blood sugar readings, received Novolog per NP orders, and was transferred to the hospital after the MD evaluated the resident.
A resident with fractures, multiple falls, obesity, and moderate cognitive impairment was dependent on 2 staff and a hoyer lift for transfers and toileting, but staff moved her to the toilet without the hoyer when she was trying to get up urgently. During the return transfer, her legs gave out and she was lowered to the floor; the event was not promptly documented or reported, and she later developed new left lower-extremity fractures confirmed by x-ray and hospital evaluation.
The facility failed to ensure timely notifications and proper documentation for several residents. A resident with fractures was lowered to the floor during a transfer, but the incident was not promptly reported to management or the physician, and later imaging showed new fractures. A resident with diabetes had insulin orders left pending after a pharmacy change, resulting in missed insulin and no physician notification. Two residents with hypotension received Midodrine without proper BP parameters or documentation of physician notification when doses were given outside ordered limits.
A facility failed to ensure nail care was provided for two residents who needed ADL assistance. One resident with severe cognitive impairment and another resident who was cognitively intact but needed help with personal hygiene were both observed with long, jagged, soiled fingernails on multiple occasions. Staff said nail care should be done during showers or bed baths, but it was not completed as expected, and one resident reported asking for help without receiving it.
A facility failed to timely release a resident’s medical records to the resident’s representative. The resident had fractures of the right fibula and left calcaneus, and the records request was held up with the facility’s legal team while the family was not informed of the delay.
A resident with moderate cognitive impairment, a history of falls, and transfer orders for a Hoyer lift only was moved by staff using a stand-pivot approach when she urgently needed the toilet. During the transfer back to bed, her legs gave out and she was lowered to the floor, then later found to have new left fibula and ankle fractures. The CNA told an LPN about the incident, but it was not documented or reported to management at the time, and the NHA later stated the event was not reported to the State Agency when she learned the resident had fallen after being transferred incorrectly.
Failure to Monitor Blood Glucose and Follow Insulin Orders
Penalty
Summary
The facility failed to monitor blood glucose levels and follow hospital discharge insulin orders for a resident admitted with Type I Diabetes Mellitus with Hyperglycemia, Hyperthyroidism, and Atrial Fibrillation. The hospital discharge instructions directed continuation of insulin Lispro via a patient-supplied insulin pump, but the facility did not add blood glucose monitoring when transcribing the orders. A nursing note documented that medications were to be continued per the after-visit summary, and the resident’s medications were reviewed and verified against the discharge summary. When the resident later became clammy and unable to talk but still responsive to verbal stimuli, blood sugar testing showed a HI reading. The NP ordered 10 units of Novolog, then 8 more units after the reading remained HI 20 minutes later, and the MD in the building ultimately ordered transfer to the hospital. During interview, the LPN stated the resident was admitted with an order to continue the insulin pump and confirmed blood sugar monitoring was not added when the orders were transcribed.
Unsafe transfer and toileting led to resident fracture
Penalty
Summary
The facility failed to ensure transfers and toileting were completed according to the resident’s care plan and failed to follow its fall policy for a resident who had significant mobility limitations and was dependent on staff for transfers and toileting. The resident had diagnoses that included fractures, multiple falls, obesity, and moderate cognitive impairment. Her care plan directed that she receive assistance of 2 people with a hoyer lift for transfers, extensive assistance from 2 people for bed mobility, and dependent assistance from 2 people for toileting, with a bed pan to be offered if she needed the bathroom urgently. On the morning of the incident, the resident was calling for help and trying to get to the toilet. Staff reported that she was moved from the bed to a wheelchair and then to the toilet without using the hoyer lift because she was trying to get out of bed and staff did not wait for additional help. When staff later attempted to move her from the toilet back to the wheelchair, her legs gave out and she was lowered to the floor. Staff then used the hoyer lift to return her to bed. The incident was not documented or reported at the time by the LPN who later assessed her, and the resident’s pain was not fully evaluated after the event. After the transfer incident, the resident developed increasing left leg pain and later imaging showed new fractures of the left fibula and ankle, including the medial malleolus and suspected lateral malleolus fracture. Hospital records stated the left ankle fracture was new, and the hospital noted the injury may have occurred at the facility. Interviews with staff showed that the resident was supposed to be transferred only with a mechanical hoyer lift and that she was never found safe to stand or pivot for transfers. The DON stated the CNA should have called for assistance before attempting the transfer, and the NHA later stated she was made aware that the resident had sustained a fall after being transferred incorrectly by staff.
Failure to Notify Physician and Family of Resident Events and Medication Issues
Penalty
Summary
The facility failed to ensure timely notifications to the resident, the resident’s physician, and family member after a resident was lowered to the floor during a transfer. Resident #101 had diagnoses including fractures to the right fibula and left calcaneus, multiple falls, and obesity, and required extensive assistance with transfers and toileting. On 6/23/26, staff attempted to transfer the resident from the bed to the wheelchair and then to the toilet using a gait belt and without the hoyer lift the resident normally required. During the return transfer, the resident’s legs slid out and she was slowly lowered to the floor. The incident report documented that the resident did not hit her head, and staff later notified the administrator, DON, physician assistant, and family member on 6/26/26. The record showed that the incident was not promptly reported to management or the physician at the time it occurred. CNA J stated she informed LPN F later that day, but LPN F said she did not document the incident or report it to management and/or the physician because she believed it was not a fall if there were no injuries. The DON stated he first learned of the event from the therapy director on 6/26/26. Subsequent imaging showed an acute distal diaphyseal fracture of the fibula with comminution and mild displacement, and the hospital emergency department record noted new medial and lateral malleolar fractures along with a diaphyseal fracture of the fibula. The facility also failed to ensure physician notification and continuity of medication administration for a resident with diabetes when insulin orders were changed and left pending confirmation. Resident #102 had type 2 diabetes mellitus. On 7/12/26, staff discovered that the resident’s blood sugar checks and insulin orders had been discontinued in the MAR after the pharmacy changed the insulin names shortly after admission, leaving the replacement orders pending confirmation. The resident had only received insulin and a blood sugar check one time on 7/10/26 until the issue was identified. LPN G contacted the on-call manager for help activating the pending orders, but did not contact the physician. RN D reported that Toujeo was not available from backup supply on 7/10/26 and she did not notify the physician, and RN C also did not notify the physician when she learned on 7/12/26 that the resident had not received insulin since 7/10/26. The facility further failed to ensure appropriate physician notification and order parameters for Midodrine administration for residents with hypotension. Resident #104 had orthostatic hypotension and was receiving Midodrine three times daily, but the order did not include blood pressure parameters and there was no order to check blood pressure. Nursing staff documented blood pressures that varied across the day, and RN C later contacted the PA to request parameters after medication had already been given. Resident #105 also had hypotension and was prescribed Midodrine three times daily for systolic blood pressure less than 90, yet the MAR showed the medication was administered on multiple occasions when the systolic blood pressure was above 90. Aside from one note indicating the resident requested the medication due to dizziness, there was no documentation that the physician had been notified for the other doses given outside the ordered parameters.
Failure to Provide Nail Care for Dependent Residents
Penalty
Summary
The facility failed to ensure dependent residents received nail care as part of ADL assistance. Resident #101, a female with debility, left-sided hemiparesis, and late onset Alzheimer’s disease, had an MDS showing a BIMS score of 6/15 and was dependent for personal hygiene. Although her task list showed a bed bath twice weekly, her fingernails were observed on multiple occasions to be long, jagged, and soiled with black debris while she was in bed. Staff interviews indicated nail care was expected during bed baths or showers, and an LPN later cleaned and clipped her nails after a CNA reported being unsuccessful. Resident #104, a cognitively intact male with a Stage IV sacral pressure ulcer, numbness of the right lower extremity, and right hand pain, required partial moderate assistance with personal hygiene and had bathing/showering tasks scheduled twice weekly. His fingernails were observed to be long, jagged, and soiled with dirt and debris on two separate observations. He stated he preferred to keep his nails short and clean and had asked for help but had not received any yet, and also reported staff had not offered to cut his nails. Staff interviews stated nail care should be completed with showers or bed baths, or when needed, and the DON stated nail care was considered standard of care and expected to be completed with assigned shower days or as needed.
Delayed Release of Resident Medical Records
Penalty
Summary
The facility failed to release medical records to a resident or the resident’s legal representative in a timely manner for Resident #101, resulting in delayed access to the resident’s medical records. Resident #101 was admitted with diagnoses including fractures of the right fibula and left calcaneus. The resident’s family member submitted an authorization for release of health information, signed by the resident, requesting the records, but the facility did not contact the family regarding the request for an extended period. During interview, the Nursing Home Administrator reported that the request had been received but was held up with the facility’s legal team, and the family was not informed of the delay until the day of the interview.
Failure to Timely Report Alleged Neglect After Improper Transfer and New Fractures
Penalty
Summary
The facility failed to timely report an allegation of neglect involving a resident who had multiple fractures, moderate cognitive impairment, obesity, and a history of falls. The resident’s care plan required transfers with a Hoyer lift and assistance from two people, and the fall care plan identified the resident as being at increased risk for falls. Despite these interventions, staff attempted to move the resident without following the planned transfer method when the resident urgently needed to use the bathroom. During the incident, the resident was found sliding off the bed and screaming for help. Staff first moved the resident from the bed to a wheelchair and then to the toilet using a stand-pivot type transfer rather than the required mechanical lift. When staff later tried to return the resident to the wheelchair and then to bed, the resident’s legs gave out and she was slowly lowered to the floor. Staff then used the Hoyer lift to transfer the resident back to bed. The CNA involved reported the incident to an LPN later that day, but the LPN did not document the event or report it to management, stating she believed it was not a fall because there were no injuries. The resident later complained of left leg pain, and imaging showed a new acute fracture of the left fibula with additional ankle fractures that were not present on prior hospital imaging. The resident was later sent to the hospital, where the fractures were described as new and potentially related to an injury at the facility. The DON stated the resident should only have been transferred with the mechanical lift and confirmed the resident was at high risk for fractures. The NHA stated she did not report the incident to the State Agency when she became aware that the resident had sustained a fall after being transferred incorrectly by staff.
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Compliance trends in Michigan
Data through Jun 2026Comparisons below measure the most recent period Jul 2025 – Jun 2026 against the prior period Jul 2024 – Jun 2025 (two equal 12-month windows). The most recent 1 months are excluded because CMS is still publishing them.
Top tags by month · last 24 months
dashed = still reportingMonthly citation counts for the 5 most-cited tags. The dashed tail is the 1-month reporting lag.
Frequency movers
Biggest change in how often each tag is cited, as a rate per 100 inspections (so it isn't skewed by survey volume): Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. Only tags with at least 20 citations in both periods are shown.
Severity movers
Tags whose average scope/severity shifted the most: Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. The number is the average severity on the A–L scale (A=0…L=11); the letter is the band it falls in. A rise means the same tag is being cited at a more serious level — note the average can move enough to rank here while staying within the same letter. Same 20-citation minimum applies.
Care domain movers
Citations grouped into CFR care domains — F-tags by their §483 regulatory section (CMS State Operations Manual, Appendix PP) — measured as a rate per 100 inspections: Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. Share is the domain's portion of citations this period; avg severity is the mean scope/severity letter and immediate jeopardy the percentage cited at J–L, both over the current period. Domains with at least 20 citations in both periods are shown; the sparkline tracks the last 12 months (left = oldest).
Immediate jeopardies · this period
Citations at the most serious scope/severity — J–L, immediate jeopardy, residents placed at risk of serious harm or death — over Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. "Surveys with an IJ" counts distinct health inspections that had at least one.
Survey activity · by month
faded/dashed = still reportingCitations each month split into complaint-driven (unscheduled, triggered by grievances) vs standard surveys — bars, left axis — with the number of inspections as a line on the right axis. Rising inspections signal more scrutiny; a rising complaint share means more off-cycle surveys. The most recent 1 months are still being reported.
Deficiency-free survey rate
Share of health surveys that found zero deficiencies — the odds of a clean survey. Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025; the most recent 1 months are still being reported (dashed).
Penalties · by month
faded = still reportingTotal civil money penalty dollars imposed on the state's facilities each month — how hard the state is enforcing. The most recent 1 months are still being reported, and penalties often lag citations by several months.
Emerging tags
Tags that weren't established last period but surged — an early warning, distinct from movers (which track already-common tags). Criteria: fewer than 20 citations in the prior period, but at least 10 this period and 2.5× their prior volume. The sparkline shows monthly counts over the last 12 months (left = oldest).
Trusted data from CMS and state health departments
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