F 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
Based on record review and interviews, the facility failed to provide treatment to a pressure ulcer upon
admission to the facility for 1 of 3 residents sampled (Resident #1).
Residents Affected - Few
The finding include:
On 4/30/24, a review of Resident #1's medical records was conducted. Records revealed Resident # 1 was
discharged to hospital on 2/26/24 and re-admitted to facility on 3/7/24 with a new diagnosis of an
unstageable pressure ulcer of the sacral region. The resident was incontinent of bladder and bowel upon
admission to the facility on 3/7/24. admission orders did not include treatment specific for the pressure ulcer
until 3/9/24. A physician's order dated 3/9/24 stated Dakin's external solution (a dilute solution used as an
antiseptic to cleanse wounds in order to prevent infection), apply to sacrum topically every day shift for
wound care, cleanse wound area with Dakin's solution, pat dry, skin prep perimeter of wound and apply
santyl ointment (a debriding ointment that contain an enzyme to allow for wound healing and growth of
healthy tissue) to eschar ( a dry, dark scab) of wound and hydrogel to redden area of wound, cover wound
with foam dressing.
On 4/30/24 at 12:52 PM, an interview was conducted with Staff A, a Physician Assistant (PA) and facility's
wound care specialist. During the interview, she reviewed Resident #1's physician's orders and stated
Resident #1 should have been admitted with orders for the care of the pressure ulcer. Staff A verified
Resident #1 did not have orders for care of the unstageable pressure ulcer until 2 days after arrival to the
facility.
On 4/30/24 at 3:26 PM, an interview was conducted with Director of Nursing (DON). She was asked the
reason Resident #1 did not receive treatments for the pressure ulcer upon arrival to the facility on 3/7/24.
The DON stated that Resident #1 had the wound cleaned and a barrier cream applied so he did have the
skin treated on 3/7/24. Further review of the orders with the DON indicated an order of Barrier cream to
scrotum/peri area every shift and as needed after each incontinence episode every shift for skin impairment
dated 2/9/21 and re-started on 3/7/24. The DON stated this order was consistent with facility protocol for
skin care for residents who were incontinent. The DON verified an order for Dakin's (1/2 strength) external
solution, apply to sacrum topically every day shift for wound care cleanse wound area with Dakin's solution
pat dry, skin prep perimeter of wound and apply santyl ointment to eschar of wound and hydrogel to redden
area of wound, cover wound with foam dressing dated 3/9/24, two days after arriving to facility.
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:
105563
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
105563
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/30/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Centre Pointe Health and Rehab Center
2255 Centerville Road
Tallahassee, FL 32308
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
Level of Harm - Minimal harm
or potential for actual harm
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
Based on interviews and record review, the facility failed to ensure that wound care documentation was
completed for 2 of 3 residents sampled for wound care (Resident #2 and #3).
Residents Affected - Few
The findings include:
Resident #2
On 4/30/24 at 10:05 am, an interview was conducted with Resident # 2. During the interview, she stated
facility staff was not consistent with her wound care.
On 4/30/24, a review of Resident #2's medical records was conducted. There was a physician's order for
nystatin-triamcinolone cream twice a day for skin management with a start date of 4/24/24. The Medication
Administration Record (MAR) was reviewed and revealed that, on the 4/25/24 evening shift and 4/27/24 day
shift, the documentation was not completed. Another physician's order indicated to apply zinc barrier cream
to the buttocks, groin and perineal area, clean with soap and water, pat it dry and apply zinc ointment two
times a day for excoriation and skin breakdown with a start date of 3/24/24. The MAR was reviewed and
revealed that, on 4/21/24 at 9:00 am and 6:00 pm, on 4/25/24 at 6:00 pm, and on 4/27/24 at 9:00 am, the
documentation was not completed.
Resident #3
On 4/30/24 at 10:30 AM, an interview was conducted with Resident #3. During the interview, he stated the
facility had missed some of his wound care treatments.
On 4/30/24, a review of Resident #3's medical records was conducted. There was a physician's order for
Triad Hydrophilic Wound Dress Paste, apply to sacrum and both buttock topically every shift for skin
management, evaluate for pain prior to, during, and after treatment and medicate as needed, monitor site
for signs and symptoms of infection and notify the Practitioner as needed with a start date of 4/4/2024. The
MAR was reviewed and revealed that the documenation was not completed for the daytime applications on
4/16/24 and 4/21/24 and for the evening applications on 4/14/24, 4/15/24, 4/20/24, 4/21/24, and 4/25/24.
On 4/30/24 at 3:26 PM, an interview was conducted with Director of Nursing (DON). During the interview,
the DON reviewed Resident #2 and #3's MAR's. She stated there was facility protocols to document if
treatment was given, if it was refused, or the reason it was not given. The DON further stated facility would
educate staff that did not document the MARs.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105563
If continuation sheet
Page 2 of 2
