Inspection·December 11, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 follow a physician's treatment order for a resident (R1) with a stage 3 pressure injury to the sacrum. The facility also failed to inform R1's physician of a newly identified pressure injury wound. This applies to 1 of 4 residents reviewed for pressure injuries. Residents Affected - Few The findings include: R1's EMR (Electronic Medical Record) showed R1 had an unhealed chronic stage 3 pressure injury to his sacrum. R1's Braden Scale assessment dated [DATE] showed R1 was at a High Risk for pressure injuries. R1's care plan dated 12/10/2024 showed R1's wound interventions included Treatment as ordered and Wound care consultation as ordered. On 12/10/2024 at 11 AM, R1 was in bed. R1 said last night he had discomfort in his wound area. R1 said he felt as if something was pinching him. On 12/10/2024 at 10:30 AM, V3 (Wound Care Nurse/WCN) was asked to perform wound care to R1's sacral wound. V6 (Hospice Aide) assisted V3 (WCN) with turning R1 in bed for wound care. R1 had an unsecured ABD pad dressing loosely covering his sacrum and buttocks. V3 removed the ABD dressing, and there was a dry 4x4 gauze dressing covering the sacral wound bed. The gauze dressing was adherent to the wound bed and stained with dry serosanguinous drainage, V3 had to moisten the gauze with normal saline to remove the dressing. The peri-wound area was red and irritated, and R1's right buttock had a partially open maroon blister that was bleeding. V3 said it appeared like a popped blood blister. V3 said it was a new DTI (deep tissue injury) pressure wound that measured 4 x 1.5 x 0.5 cm (centimeters). V3 proceeded to clean both wounds and then applied Nystatin (antifungal) cream directly on the sacral wound bed then covered it with a Calcium Alginate dressing. V3 then covered both wounds with an adherent boarded foam dressing. On 12/10/2024 at 1:30 PM, V3 (WCN) said she changed R1's daily sacral wound dressings. V3 said R1's wound was chronic, and would close and reopen. V3 said she had noticed R1's wound bleeding at times and was unsure of the cause. V3 said she does not follow R1's ordered treatment because she feels that the ABD dressing would provide more cushion versus the ordered foam dressing. V3 also said she did not follow the treatment order for the foam dressing because she felt it would not stay on properly. V3 continued to say that she had notified V12 (Wound Physician) of R1's new right buttock wound in the morning and entered a wound care order in R1's EMR. On 12/10/2024 at 3 PM, V12 (Wound Physician) said he had been treating R1's sacral wound for a long time. V12 said the wound would heal and then reopen. V12 said R1 was at high risk for skin (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: 146008 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 146008 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden of Waterford 2021 Randi Drive Aurora, IL 60505 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)