Health inspection·September 14, 2023

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement specific interventions to prevent pressure ulcers from developing to a resident assessed as high risk. This applies to one of three residents (R1) reviewed for pressure ulcers. Residents Affected - Few The findings include: The EMR (Electronic Medical Record) showed that R1, an [AGE] year-old with diagnoses that include but not limited to diabetes mellitus type 2, dementia, hypertension, Alzheimer's disease, cerebral infarction, hyperlipidemia, hyperkalemia, lack of coordination, weakness, kidney failure, metabolic encephalopathy, obesity, psychotic, mood and anxiety disturbance, and cognitive communication deficit. R1 was admitted to the facility on [DATE]. The MDS (Minimum Data Set) dated 7/25/2023 showed that R1 was severely impaired, required extensive to total assistance with ADLs (Activities of Daily Living) such as transfer, bed mobility, hygiene and eating. The MDS also showed that R1 had functional impairment of range of motion on one side of the body of the upper extremity and both sides of the lower extremities. The assessment showed that R1 had no pressure ulcers, no DTI (deep tissue injuries) that were pressure related, no open lesions, diabetic ulcers or any kind of ulcers or tissue injuries of the feet. The initial nursing assessment dated [DATE] showed that R1 was free of skin alteration and had no pressure ulcers. On 9/11/2023 at 2:00 P.M. the Braden Scale skin assessments and current care plan was reviewed with V3 (Director of Nursing) and V4 (Licensed Practical Nurse/Wound Care Nurse). V3 and V4 stated that the Braden Assessment of 7/18/2023 with a score of 17 (at risk for pressure ulcer development) was not accurate. V3 and V4, said that if the Braden Assessment was done correctly, the score should be 11 and that would place R1 as high risk of developing pressure ulcer. The Braden Scale dated 7/26/2023 showed that R1 had a score of 11. The current care plan initiated on 7/19/2023 showed that there were no specific interventions to prevent R1 from development of pressure ulcer. The care plan was discussed with V3 and V4. Both have confirmed that there were no specific interventions to prevent R1 from development of pressure ulcer. In fact, they both said that heel protectors were only applied on 9/5/2023 when R1's daughter had discovered the unstageable pressure ulcer to R1's both heels on 9/5/2023. The care plan was updated on 9/7/2023 for R1 to always have the heel protectors after the discovery of the unstageable pressure ulcer of both heels. V4 said that on 9/5/2023, R1's daughter had complained regarding a skin tear to R1's right lower leg. V4 added that due R1's daughter complaint, V4 did skin assessment on same day with R1's daughter at bedside and V3. Both V3 and V4 said that they assessed R1's heels as black discoloration to both heels which were unstageable pressure ulcer. (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 3 Event ID: 146067 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 146067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Geneva 1101 East State Street Geneva, IL 60134 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)