Inspection·June 5, 2024

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 observation, record review and interview the facility failed to provide pressure ulcer treatments as ordered for one resident (R3) reviewed for pressure areas in the sample of three. Residents Affected - Few Findings include: An October 2010 policy titled Wound Care documents the steps in the procedure of changing a wound dressing include: 4. Put on exam gloves. Loosen tape and remove dressing. 5. Pull glove over dressing and discard into appropriate receptacle. Wash and dry your hands thoroughly. R3's Physician Order Sheet (POS) documents a treatment of heel protectors on at all times. The order documents, Schedule: Every day at 6:00 AM - 6:00 PM; 6:00 PM - 6:00 AM. Protocol: As tolerated, (R3) does not like the heel protectors and often prefers pillow instead for offloading. R3's POS documents an order dated 05/09/24 for a 0.25% sodium hypochlorite solution to be applied to R3's right heel with moist gauze only over eschar area (cut to fit), apply barrier around the wound, cover with an abdominal pad and gauze wrap, change daily. On 06/04/24 at 3:55 PM a progress note written by V3, Nurse Practitioner, documents R3 has a right heel unstageable pressure ulcer with suspected deep tissue injury. On 06/04/24 at 11:39 AM, V2, Director of Nursing entered R3's room, asked if R3 was having pain and proceeded to remove R3's blankets from the end of his bed exposing R3's feet which were in socks. R3's heels were not elevated using offloading boots or pillows. V2 stated to R3, We need to get your heel protectors on you. V2 removed R3's sock from his right foot which showed a soiled foam bordered dressing on his inner heel with writing on it that documented, 05/30/ (2024). V2 was asked what date was on R3's right heel dressing. V3 stated, 05/30. V2 stated, They're good for three to five days. V2 was asked how often the sodium hypochlorite dressing was to be applied. V2 stated it was to be changed daily but nursing can just peel back the foam bordered gauze and replace it. Manufacturer's instructions of the foam bordered dressing document, If reused, performance of the product may deteriorate, cross contamination may occur. On 06/04/24 at 2:12 PM, V2 confirmed R3's order was for the sodium hypochlorite on moist gauze (cut to fit eschar area only), followed by an abdominal pad and gauze wrap. This dressing was to be changed daily. V2 confirmed that nursing was peeling back and reusing the foam bordered gauze for the six days it was in place. 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: 145457 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 145457 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Quincy Healthcare & Sr Living 1440 North 10th Street Quincy, IL 62301 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)