Health inspection·April 6, 2023

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 Based on interview and record review, the facility failed to transcribe and follow physician orders for wound treatment of a surgical wound for 5 days, and failed to notify the resident representative of the treatment plan to leave sutures in place beyond the usual time frame, for 1 of 1 resident (R2) reviewed for physician orders and notification. Residents Affected - Few Findings include: On 3/31/23 at 10:44AM, V18 (R2's family) said the facility left R2 sutures in longer than they were supposed to, and the sutures were supposed to only stay in for 10 days. V18 said R2 got sutures on 2/14/23 after sustaining a laceration to the right leg when she was being transferred to bed. R2's face sheet shows R2 has diagnosis of pain in left shoulder, pain left knee, atherosclerotic heart disease, heredity and idiopathic neuropathy, obesity, bilateral artificial knee, urinary tract infection, other abnormalities of gait and mobility, other reduced mobility, abnormal posture, history of falling. R2's face sheet denotes R2 has a power of attorney for care. R2 MDS (Minimum Data Set), dated 1/4/23, denotes, in-part, R2's BIMs score of 11 (mild cognitive impairment). On 4/4/23 at 10:27AM, V11 (wound treatment nurse) said R2 sustained a laceration to the right leg during a wheelchair to bed transfer. V11 said R2 saw the wound doctor on 3/1/23, and the wound treatments to the right leg was changed on 3/1/23. V11 said the orders were not initiated until 3/6/23. V11 said the orders were changed to Bactroban and calcium alginate. V11 said Bactroban is an antimicrobial that treats and prevents infections, and calcium alginate is used as an absorbent with there is exudate from the wound. V11 said physician orders should be implemented immediately when ordered. V11 said initiating the wound treatment on 3/6/23, five days after the physician order, was not appropriate when following physician orders. V11 (wound treatment nurse) said the plan was to keep R2's sutures in place longer than usual. V11 said the physician removed several sutures from R2's right leg wound, and the plan was to keep the 3 sutures in place so that the wound would not fail (open). V11 said she did not discuss this with the family, she only informed the family that the wound was stable. V11 said a care plan was not developed for the sutures, there was a plan of care for the right leg wound. Review of R2's wound care assessment and progress note, dated 3/1/23, denotes, in-part, exam, reviewed patients' chart, discussed prognosis and tx (treatment) options with nursing staff and patient, removed all non-productive sutures today, leaving distal 3 present for removal next week. Dressed RLE (right lower extremity) wound with Bactroban, adaptic, calcium alginate and foam island, continue 3x/wk (week) after 0.9% NS( normal saline) and cover with tubi grip and derma saver. Dressed LLE Page 1 of 2 145382 145382 04/06/2023 Lee Manor 1301 Lee Street Des Plaines, IL 60018

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (left lower extremity) wound with Bactroban and foam island, continue 3x/week after 0.9% NS (normal saline) wash and cover with tubi-grip and derma saver. R2's physician order sheet, dated 3/3/23 with start date of 3/6/23, denotes, in-part; apply to RLE (right lower extremity) laceration topically every day shift every Monday, Wednesday, Friday for wound care after 0.9NS (normal saline) cleanse and cover with adaptic, calcium alginate and bordered foam. cover with tubi-grip and derma saver to RLE (right lower extremity). On 4/4/23 at 2:24 PM, V17 (Director of Nursing) said the nurse should follow physician orders when they are received. V17 said it is her expectation that the nurse transcribe and carry out orders before their shift ends. V17 said it is her expectation that a STAT (emergency) order is carried out immediately. On 4/4/23 at 2:35 PM, V20 (wound physician) said he expects the facility to follow any orders that he gives for treatment. V20 said he ordered the calcium alginate because R2 had small drainage to the right leg wound.V20 said the calcium alginate was not vital to treatment, it was for absorption. V20 said he saw R2 on 3/1/23, and R2 did not have any signs of infection to the right leg wound, no redness, no swelling. V20 said he removed the non-vital sutures on 3/1/23, and the plan was to leave the sutures in for a longer period so that the wound did not open up. V20 said R2 had poor circulation, and that would affect wound healing. Facility policy titled Change in a resident's condition or status, denotes in-part our facility shall promptly notify the resident, his or her attending physician and representative (sponsor) of changes in the residents medical/mental condition and/or status. Facility policy titled wound care denotes in-part the purpose of this is to provide guidelines for the care of wounds to promote healing. Verify that there is a physician order for procedures. Assemble the equipment and supplies as needed. Dressing material as indicated; antiseptic as ordered. 145382 Page 2 of 2