Inspection·July 9, 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, interview and record review, the facility failed to assess, notify the physician and obtain a treatment order for a newly identified pressure wound for one of three residents (R2), reviewed for pressure wounds, in a sample of 3. Residents Affected - Few The facility policy, Decubitus Care/Pressure Area, dated (revised) 1/18 documents, It is the policy of this facility to ensure a proper treatment program has been instituted and is being closely monitored to promote the healing of any pressure ulcer. Upon notification of skin breakdown, the pressure area will be assessed and documented on the Treatment Administration record or the Wound Documentation Record. Document size, stage, site, depth, drainage, color, odor, and treatment (after obtaining from the physician). Notify the physician for treatment orders. The orders should include: type of treatment, frequency treatment is to be performed, how to cleanse, site of application. R2's (Hospital) After Visit Summary, dated 6/29/24 to 7/5/24 documents that R2 was readmitted to the facility with the following diagnoses: Closed Fracture of Neck of Right Femur and Compression Fracture of T (Thoracic) 12 Vertebra. R2's Nurses Notes, dated 7/5/24 and signed by V11/Agency Licensed Practical Nurse document, (Nurse) called facility to give report regarding (R2) discharge from hospital. (R2) has right hip fracture, superior and inferior pubic (ramus) fracture and T12 compression fracture. Has some shearing to left buttock. R2's Nurses Notes, dated 7/5/24 and signed by V10/Agency Licensed Practical Nurse document, (R2) arrived to this facility at 5:58 P.M. Skin assessment performed. Bruising noted to bilateral forearms. Surgical site noted to right hip. Dressing dry and intact. Opened area noted to upper right (left) buttock. Right and left buttocks red. Bilateral heels boggy. R2's facility Nursing admission Assessment, dated 7/5/24 and completed by V10/Agency Licensed Practical Nurse documents, Opened area to left buttock. R2's current Treatment Administration Record, dated July 2024 and verified by V4/Agency Registered Nurse, documents, (7/8/24) Right hip surgical incision. No note of the pressure wound to R2's left buttock or a physician's order to treat the wound to R2's left buttock, is noted. On 7/9/24 at 12:18 P.M., V8/Agency Licensed Practical Nurse removed a heavily feces-soiled, undated bandage from R2's left buttock. An inverted V-shaped, Stage 2 pressure wound, measuring 2.5 CM (Centimeters) X 1.5 CM was present. At that time V8/Agency Licensed Practical Nurse verified she was unaware of the pressure wound and no previous assessment of the wound, physician notification or physician's orders for the treatment of the wound were completed. 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 5 Event ID: 145886 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 145886 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Aledo 304 S.W. 12th Street Aledo, IL 61231 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)