Health inspection·February 27, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, interviews, and facility policy review, the facility failed to ensure that four (Residents #13, #14, #11, and #3) of eight residents with pressure ulcers, from a sample of 18 residents, received care consistent with professional standards of practice, to prevent pressure ulcers and receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing. Residents Affected - Some The findings include: 1. A review of Resident #13's medical record revealed she was admitted to the facility on [DATE] and discharged to emergency room care on 1/21/24. A review of the Minimum Data Set (MDS) assessment Section M (Skin Conditions) dated 12/26/23 revealed the resident was assessed as at risk for developing pressure ulcers, and on that date did not have any pressure ulcers. The next MDS evaluation for Section M (Skin Conditions), dated 1/21/24, revealed the resident has one unstageable pressure ulcer/deep tissue injury which was not present at admission. A review of the resident's care plan dated 12/26/23 and revised on 1/2/24, revealed Resident #13 was at risk for skin impairment related to incontinence, at risk for malnutrition, weakness/decreased mobility, anemia. Goal revealed: the resident will free from any new skin impairment through the review date. Interventions included: encourage and assist resident to turn and reposition as tolerated. Monitor/observe skin while providing routine care. Notify nurse of any area of concern as indicated. Preventative skin treatments as ordered/indicated, as tolerated by resident. A review of Resident #13's care plan dated 1/5/24, revealed a focus area, the resident has a pressure ulcer to mid back. The goal revealed: The resident's pressure ulcer will show signs of healing as evidenced by decrease in size, improved appearance, and be free from infection by/through the review date. Interventions included: Administer medications and treatments as ordered by the MD. Encourage and assist resident to turn and reposition as tolerated. A review of the progress note dated 1/15/24 from wound care service revealed: Patient being evaluated for initial wound assessment. Location: midback. Initial wound consultation for midline midback wound over her kyphosis which appears initially as an unstageable pressure injury. Wound Assessment: Back midline is an unstageable pressure injury obscured by full thickness skin and tissue loss pressure ulcer and has received a status of non-healed. Initial wound encounter measurements are 4.7 centimeters (cm) by 1.7cm by 0.2cm depth with an area of 7.99 square cm. Wound orders: Cleanse wound with Dakins 1/4 strength, skip prep to periwound, apply honey gel to wound base and cover with silicone border foam dressing to be changed daily and as needed. Additional orders: Off-loading: Avoid direct pressure to wound site. (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 10 Event ID: 105470 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 105470 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fernandina Beach Rehabilitation and Nursing Center 1625 Lime Street Fernandina Beach, FL 32034 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)