Inspection·November 20, 2024

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 record review, resident interview, staff interview, and policy interview, the facility failed to ensure a resident received appropriate wound care to a surgical site and to a non-pressure ulcer on his right foot. They also failed to ensure wounds were assessed upon admission and weekly thereafter to monitor for healing. This affected one (#56) of three residents reviewed for wounds/ dressing changes. Residents Affected - Few Findings include: Review of Resident #56's medical record revealed he was admitted to the facility on [DATE]. His diagnoses included status post transmetatarsal amputation of the right foot on 11/06/24, osteomyelitis of the right foot and ankle, partial traumatic amputation of two or more right lesser toes, diabetes mellitus, peripheral vascular disease, and a chronic, non-pressure ulcer of the right heel. Review of Resident #56's hospital records revealed they included a Discharge summary dated [DATE]. The discharge summary from the hospital revealed the resident's care was being handed off to a primary care physician (PCP) and the PCP was to address the following: resident status post partial amputation of the right foot. The resident was discharged on oral antibiotics and he was to follow up with podiatry after discharge. Discharge medications were listed to include Augmentin 500-125 milligrams (mg) one tablet by mouth every 12 hours for seven days. The discharge summary also included the need for a future appointment on 11/14/24, with the podiatrist that did his surgery and performed the transmetatarsal amputation of the right foot. There was not any treatment orders included with the discharge summary for the resident's surgical site or the chronic, non-pressure ulcer on his right heel. Further review of Resident #56's hospital records revealed 85 pages had been scanned and uploaded into the resident's electronic medical record (EMR) under documents and included an Emergency Department (ED) to Hospital admission report dated 11/01/24. The ED to Hospital admission report included updates on the resident's medications and treatment orders. The report indicated a treatment order was received on 11/06/24 at 5:28 P.M. by the podiatrist that specified wound care the resident was to receive to the surgical site and non-pressure ulcer on his right heel. They were directed to cleanse the wounds with normal saline, apply medi-honey and cover with 2x2 gauze with the right heel then on the right do the same, but just add a small portion of Dermagran cut to fit with that to keep the area moist and cover with 2x2 gauze to the right heel keeping the forefront dressing intact. The treatment ordered was to start on 11/07/24. Review of Resident #56's admission orders provided by the Director of Nursing (DON) revealed she provided four of five pages that she said was the resident's admission orders in place at the time of his admission. Page 1 of 5 was not provided. What was provided was a list of the resident's (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 9 Event ID: 365147 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 365147 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Oaks Health Center 4114 North State Route 376 NW McConnelsville, OH 43756 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)