Inspection·February 24, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that staff provided post-surgical wound care according to current physician's orders for 1 of 3 residents (R2) reviewed for wounds in the sample of 6; and failed to follow their facility policies on following physician orders for surgical wound care. Residents Affected - Few Findings include: R2's face sheet indicated that resident admitted to the facility on [DATE] with a past medical history not limited to: chronic kidney disease, hypertension, convulsions, history of transient ischemic attack and cerebral infarction, major depressive disorder, and open wound to left foot. On 02/22/2025 at 11:37 AM, R2 was observed sitting in his wheelchair in his room wearing a slipper to his right foot, and a thick black sock to his left foot. R2 indicated that he had surgery last week and has a wound to his left foot that is painful at times. R2's Podiatrist Note by V7 (Wound Care Physician) dated 01/22/2025 at 11:42 documented that R2 underwent outpatient surgery today: excision of bone spur [left] first metatarsal. He tolerated the procedure and anesthesia well and will be discharged back to the facility today. Post op wound care orders have been entered into [electronic health record] and sent to (V6) wound nurse. Right foot should be elevated while the patient is at rest in bed. The patient may ambulate as tolerated in his post op surgical shoe and take [pain medication] as ordered for pain. Keep dressing clean dry and intact until first nurse dressing change on 01/27/2025. Call [V7] with any questions. Podiatrist Note by V7 (Wound Care Physician) dated 02/21/2025 at 16:03 documented that R2 was seen and chart reviewed .Upon removal of the silver alginate and bordered gauze dressing to the left foot there is a 2-1/2 cm (centimeter) x 4 cm stage II ulceration deep to subcutaneous tissue at the dorsal aspect of the first metatarsophalangeal joint .Following verbal informed consent I cleansed the wound thoroughly with [antiseptic povidone-iodine] solution. I then performed a thorough lavage with [antiseptic povidone-iodine] 10% solution. Next I applied collagen powder silver alginate wound pad gauze rolled gauze and [self-adherent wrap] with mild compression. I recommend this wound care be repeated every 24 hours until my next follow-up the patient in 5 days .I will also place an order with wound care nurses . On 02/22/2025 at 3:42 PM, V7 (Wound Care Physician) said that R2 has wound issues and delayed healing due to non-compliance with not wearing his surgical shoe, not elevating his leg, and continues to smoke. V7 indicated that R2 continues with antibiotic therapy, will have a doppler study done, and be seen by a vascular team next week. V7 added that R2's wound has slightly improved from 02/12/2025 (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 3 Event ID: 145173 Printed: 05/15/2026 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 145173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heather Health Care Center 15600 South Honore Street Harvey, IL 60426 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)