Health inspection·October 24, 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 Based on observation, medical record review, interview, and facility policy review, the facility failed to ensure surgical wound treatments were completed per physician order. This affected one resident (#25) of three residents reviewed for wound care. The facility census was 96. Residents Affected - Few Findings include: Review of the medical record for Resident #25 revealed an admission date of 10/27/23 with diagnoses including dementia, unspecified mood affective disorder, anxiety disorder and major depressive disorder. Review of the quarterly Minimum Data Set (MDS) assessment completed on 09/26/24 revealed Resident #25 had severely impaired cognition and was independent but required substantial assistance with bathing. Further review of the MDS revealed Resident #25 had surgical wounds. Review of the physician orders revealed an order dated 10/02/24 for wound care for the mid-upper back daily every day shift and as needed (PRN). The treatment was to cleanse area with normal saline, apply skin prep to surrounding tissue or periwound, apply silver alginate to the base of the wound, and secure with boarded foam. Review of the physician orders revealed an order dated 10/02/24 for Resident #25 was to receive wound care for the right lateral shoulder daily every day shift and as needed (PRN). The treatment was to cleanse the area with normal saline, apply skin prep to surrounding tissue or periwound, apply silver alginate to the wound bed and cover with boarded gauze dressing. Observation on 10/17/24 at 9:20 A.M. revealed Resident #25 had a dressing to the right lateral shoulder and a dressing to the mid-upper back. Both dressings were dated 10/14/24. Interview Assistant Director of Nursing (ADON) #309, at the time of the observation, revealed she was also the facility wound nurse and confirmed both dressing were applied by her on 10/14/24. Review of the undated policy titled, Wound Care, revealed residents admitted with or who develop skin integrity issues would receive treatment as indicated. This deficiency represents non-compliance investigated under Complaint Numbers OH00158714 and OH00158447. 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: 365292 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 365292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hanover Healthcare Center 435 Avis Avenue NW Massillon, OH 44646 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)