Inspection·February 19, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, record reviews, and facility policy review, the facility failed to ensure weekly skin assessments were accurate and completed as well as treatment orders being in place and timely for two ( Resident #21 and #41) out of three residents reviewed for skin breakdown. The facility census was 85. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #21, revealed an admission date of 12/2/22. Diagnoses included but were not limited to unspecified dementia, cognitive communication deficit, overactive bladder, depression, and need for assistance with personal care. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of the resident is rarely/never understood. The resident was assessed to require total dependence on toilet hygiene, shower/bathe self, bed mobility and transfers. Review of the physician's order for Resident #21 dated 01/21/25 at 10:36 A.M. revealed cleanse area under right breast with wound cleanser, pat dry and apply calcium alginate to wound bed, cover with bordered gauze island dressing every day and as needed if the dressing becomes soiled or dislodged. Review of the plan of care for Resident #21 revised on 01/28/2025 revealed this resident was at risk for skin breakdown and development of pressure injury related to skin impairment under her right breast with the intervention that included but was not limited to weekly skin assessments. Review of the medical record for Resident #21 revealed no weekly skin assessments with measurements and descriptions for the skin alteration under the right breast. Interview on 02/18/25 at 2:47 P.M. with the Director of Nursing (DON) verified Resident #21 had a treatment put in place or a skin alteration on 01/21/25 with no weekly skin documentation monitoring the wound. 2. Review of the medical record for Resident #41, revealed an admission date of 10/17/24 and a transfer to hospital date of 12/03/24. Diagnoses included but were not limited to acute kidney failure, need for assistance with personal care, dependence on renal dialysis, acquired absence of left knee, arthritis due to other bacteria, right knee, and type 2 diabetes. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of 15 out of 15 indicating intact cognition. The resident was assessed (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: 365026 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 365026 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wexner Heritage House 1151 College Avenue Columbus, OH 43209 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)