F 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on record review, policy review, and interview, it was determined, the nursing staff failed to
accurately document wound care treatment orders and the provision of wound care for 2 of 2 sampled
residents (Resident #1 and #4).
The findings included:
Review of the facility policy titled, Wound Care revised October 2010 documented, as follows:
Purpose
The purpose of this procedure is to provide guidelines for the care of wounds to promote healing.
Preparation
1. Verify that there is a physician's order for this procedure.
2.
Review the resident's care plan to assess any special needs of the resident.
Documentation
The following information should be recorded in the resident's medical record:
1. The type of wound care given.
2.
The date and time the wound care was given.
3.
The position in which the resident was placed.
4.
The name and title of the individual performing the wound care.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 2
Event ID:
105300
Printed: 05/28/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
105300
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Martin Coast Center for Rehabilitation and Healthc
9555 SE Federal Hwy
Hobe Sound, FL 33455
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0842
5.
Level of Harm - Minimal harm
or potential for actual harm
Any change in the resident's condition.
6.
Residents Affected - Few
All assessment data (i.e., wound bed color, size, drainage, etc.) obtained when inspecting the wound.
7.
How the resident tolerated the procedure.
8.
Any problems or complaints made by the resident related to the procedure.
1) Clinical record review conducted on 03/07/24 revealed Resident #1's physician's orders for wound care
dated 02/10/24, documented Wound care TO BE COMPLETED BY FLOOR NURSE, Right posterior thigh:
cleanse with normal saline, pat dry, apply calcium alginate and cover with foam border dressing on Monday,
Wednesday and Friday, and as needed.
Review of the administration records revealed the following:
On 03/4/24, 03/01/24, 02/28/24, the record indicates the nurse signing the administration record, noted the
provision of wound care was administered by another staff, either the supervisor or the night nurse. On
02/23/24 the nurse signing the administration record documented, Per Resident the wound care was done
by another nurse.
Interview with the Director of Nursing conducted on 03/07/24 at 1:48 PM confirmed the nursing staff is not
documenting the provision of wound care accurately. The staff performing the treatment is not signing the
administration record, with the type of treatment provided, dates and times.
2) Clinical record review conducted on 03/07/24 revealed Resident #4 had a wound care consult on
02/22/24. The physician documented the treatment for the wound, cleanse right buttocks with normal
saline, pat dry, apply calcium alginate and cover with border dressing daily, and as needed.
The physician's order for wound care was not documented on the clinical record until 02/24/24.
The administration record dated 02/2024 indicated the resident did not receive the treatment on 02/22/24,
02/23/24 and 02/25/24.
Interview with the Wound Care Nurse conducted on 03/07/24 at 1:36 PM verified the nurse did not
document the treatment order or the provision of wound care for Resident #4. The nurse explained she did
the treatment but did not write the order, it was missed, she then realized it and wrote the order on
02/24/24.
The review determined the wound care nurse and floor nurses are not documenting the provision of wound
care as delineated in the facility policy.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105300
If continuation sheet
Page 2 of 2
