Health inspection·September 26, 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 medical record review, staff interview, and policy review, the facility failed to properly assess and treat a resident's rash. This affected one (#1) out of three residents reviewed for a change in condition. The facility census was 69. Residents Affected - Few Findings include: Review of the medical record revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included dementia, anxiety, depression, hypertension, muscle weakness, and need for assistance with personal care. Review of the admission Minimum Data Set assessment, dated 07/19/24, revealed Resident #1 was identified as cognitively impaired. The resident required assistance from staff for all activities of daily living. Review of Resident #1's medical record for 09/06/24 and 09/07/24 revealed no other information, documentation, or assessment regarding a rash. Review of the shower sheet dated 09/07/24, revealed Resident #1 had a rash on their left thigh. Review of the nursing progress notes dated 09/08/24 and timed 10:00 A.M., revealed the nurse on duty noted a red rash on the top of Resident #1's left thigh and lower back. A State Tested Nurse Aide (STNA) reported the rash was reported to the unit managers on 09/06/24. The nurse on duty notified the on-call provider who ordered Acyclovir (anti-viral) medication. The provider on call and the family were notified via phone. Review of the skin assessment dated [DATE] indicated Resident #1 had a rash on the front of their left thigh and on their lower back, extending from the left flank to the right flank. Interview on 09/26/24 at approximately 10:42 A.M., with the Director of Nursing, revealed Resident #1's rash was reported to Licensed Practical Nurse (LPN) #167 on 09/06/24. LPN #167 reported the rash to LPN Supervisor #171. LPN #171 then reported the rash to the DON. The DON verified there was no documentation to support the facility had identified, assessed, or obtained treatment orders for the rash until 09/08/24. Review of the policy titled Notification of Changes, dated February 2023, revealed the need to alter treatment significantly was defined as needing to stop a form of treatment due to adverse consequences (such as adverse drug reaction), or commence a new form of treatment to deal with a problem. (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 4 Event ID: 365329 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 365329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Embassy of Marion 175 Community Drive Marion, OH 43302 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)