Health inspection·January 30, 2020

F 0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Residents Affected - Few Based on record review, observation, resident interview, and staff interview, the facility failed to revise the care plans when new conditions were identified for two (#33 and #102) out of 26 residents reviewed for care plans. Facility census was 131. Findings include: 1. Review of the medical record revealed Resident #33 was admitted on [DATE]. Diagnoses included multiple sclerosis, pseudomonas, anoxic brain damage, chronic respiratory failure, tracheostomy, gastrostomy, epilepsy, dysphagia, tachycardia, altered mental status, and supplemental oxygen. Review of the quarterly Minimum Data Set assessment, dated 11/05/19, revealed Resident #33 had moderately impaired cognitive skills, required total dependence from staff for all activities of daily living. Resident #33 has impairments to bilateral upper and lower extremities. Review of Occupational Therapy (OT) notes, dated 05/30/19, revealed a goal for Resident #33 to tolerate assessment and trial/provision of hand splint for right hand with contractures noted at proximal interphalangeal (PIPS) of all fingers excluding thumb. Review of the current care plan did not address Resident #33's care of contractures of the PIPS. Observation on 01/28/20 at 10:00 A.M. revealed Resident #33 was in bed with head of bed elevated. The resident's right hand was across chest with contractures to the PIPs of four fingers, excluding the thumb. Interview on 01/29/20 at 2:22 P.M. with the Director of Nursing (DON) verified there was no care plan for Resident #33's contracture. 2. Review of the medical record for Resident #102 revealed an admission date of 10/02/19. Diagnoses included atrioventricular block, neuromuscular dysfunction of the bladder, morbid obesity, encephalopathy, chronic obstructive pulmonary disease (COPD), bradycardia, atrial flutter, acute kidney failure, and diabetes mellitus. Review of acute charting guidelines for Resident #102 dated 12/28/19 revealed the resident had a new skin issue on his left heel. Page 1 of 2 365375 365375 01/30/2020 Meadowbrook Care Center 8211 Weller Road Cincinnati, OH 45242

F 0656 Level of Harm - Minimal harm or potential for actual harm Review of nurse progress notes for Resident #102 dated 12/28/29 revealed the resident was assessed to have an unstageable pressure ulcer to the left heel. Review of the skin grid for Resident #102 dated 12/28/19 revealed the resident was assessed to have an open lesion on the left heel Residents Affected - Few Review of then Minimum Data Set (MDS) 3.0 assessment, dated 01/01/20, revealed Resident #102 had intact cognition, required extensive assistance for activities of daily living (ADLs). Review of section M (skin conditions) revealed resident was assessed with an unstageable pressure ulcer due to coverage of wound bed by sough and/or eschar. Review of wound specialist nurse practitioner progress notes for Resident #102, dated 01/03/20, revealed resident was seen for an unstageable pressure ulcer on the left calcaneus. There was large amount of necrotic tissue within the wound bed and the wound was to be cleaned and ointment applied daily. Review of the current plan of care for Resident #102 revealed no care plan had been developed to address the care and treatment of the unstageable pressure ulcer on his left heel discovered on 12/28/19. Interview with Resident #102 on 01/29/20 at 9:35 A.M. revealed he had a sore on his left heel that was being cared for by the nurses and a wound specialist. Interview with wound Nurse Practitioner (NP) #170 on 01/29/20 at 10:00 A.M. revealed resident had an unstageable pressure ulcer on his left heel which was discovered on 12/28/19 Interview with the DON on 01/30/20 at 2:18 P.M. verified the plan of care for Resident #102 was not revised when resident was assessed to have an unstageable pressure ulcer/injury on his left heel. 365375 Page 2 of 2