Health inspection·January 14, 2026

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, interview, and record review, the facility failed to document wound assessments for two (R2, R3) of three residents reviewed on a sample list of five residents.1. R2's Care Plan, Undated, documents on 8/2/24 high risk for pressure ulcers was added, and on 10/9/24, actual pressure ulcers of sacrum, right ischium, left heel, right lateral ankle, right heel, left dorsum foot, left gluteal fold and left gluteus was added. R2's Care Plan also documents Pressure Ulcers to be assessed weekly by licensed nurse, monitor for signs of infection daily, increased warmth, redness, swelling, pain, drainage, and odor. Notify physician if not healing.R2's Treatment Administration Record (TAR) dated November and December 2025 documents order for daily foot checks related to a history of ulcers. Document color, temperature, edema, and pedal pulses. On 11/2/25 and 11/25/25, there is missing documentation. On 11/26/25-12/4/25 and 12/30/25-12/31/25 edema bilaterally was documented.R2's progress notes do not document edema, open area, treatment, or notification of physician.R2's TAR dated November and December 2025 document order of daily skin checks. Document C-clear, R-red, O-open, P-pressure, and S-skin tear. On 11/2/25 and 11/25/25, there is missing documentation. On 11/1/25, 11/3/25-11/13/25, 11/16/25-11/21/25, 11/24/25, 11/26/25-12/24/25, and 12/26/25-12/31/25, O for open is documented. On 12/11/25 and 12/19/25, O-open, R-red, P-pressure is documented.R2's Skin Observation Tool dated 10/25/25 documents R2 has skin issues to right hip, sacrum both unstageable, left gluteal fold and both heels pressure. No further documentation.R2's Skin Observation Tool dated 12/7/25 documents sacrum pressure unstageable, Right heel pressure stage 2, left heel pressure stage 2, right iliac crest pressure unstageable, redness to groin and under bilateral breasts, left gluteal fold pressure stage 3, and left foot second toe pressure stage 2. Document does not include measurements or descriptions of wounds.R2's Wound Clinic Visit Notes dated 11/7/25 document R2's wounds and measurements as follows:Coccyx Pressure Stage 4 - 2.7 centimeters (cm) x 4.5cm x 2.82cmRight Ischial Tuberosity Pressure Stage 3 - 1.7cm x 1.5cm x 1.13cmLeft Posterior Heel Diabetic Ulcer Grade 1 - 0 x 0 x 0Right lower lateral ankle Diabetic Ulcer Grade 1 - 0 x 0 x 0Left Ischial Tuberosity Pressure Stage 3 - 1.3cm x 2cm x 0.15cm.No exposed bone to Coccyx area.R2's Wound Clinic Visit Notes dated 12/5/25 document R2's wounds and measurements as follows:Coccyx Pressure Stage 4 - 2cm x 4.8cm x 2.13cmRight Ischial Tuberosity Pressure Stage 3 - 1.7cm x 1.1cm x 1.52cmLeft Posterior Heel Diabetic Ulcer Grade 1 - 0.3cm x 0.7cm x 0.1cmRight lower lateral ankle Diabetic Ulcer Grade 1 - 0.6cm x 0.3cm x 0.13cmLeft Ischial Tuberosity Pressure Stage 3 - 1.2cm x 2cm x 0.24cm.Fibrin present on wound beds, exposed bone to Coccyx area, tunneling present to right ischial tuberosity.R2's Wound Clinic Visit for 1/7/26 was missed due to refusal of transportation by R2.On 1/8/26 at 1:35PM, R2 stated the facility takes care of her wounds and she does go to an outside clinic for wound treatment but is trying to switch somewhere closer. R2's family does not want the in-house wound physician to treat R2, but it is unclear why. R2 denied pain during wound care but did state it can cause discomfort from time to time. Observation of R2's wound care was completed on 1/8/26 at 1:35PM. Measurements were taken at time and are as Residents Affected - Few (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 2 Event ID: 145469 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 145469 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Haven of Paris 1011 North Main Street Paris, IL 61944 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)