Inspection·May 7, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observation, and staff and resident interviews, the facility failed to ensure a pressure ulcer dressing change was completed per physician orders. This affected one (#93) of three residents reviewed for pressure ulcers. The facility identified four pressure ulcers in the facility. The facility census was 99. Residents Affected - Few Findings include: Review of Resident #93's medical record revealed an admission date of 11/14/23. Diagnoses included neurogenic bladder, peripheral vascular disease, depression, and diabetes. Review of the quarterly Minimum Data Set (MDS) assessment, dated 02/21/24, revealed Resident #93 was cognitively intact. Further review revealed Resident #93 required set-up and clean-up assistance for eating, partial/moderate assistance for toileting, and supervision/touching assistance for bed mobility. Additionally, Resident #93 was coded for a stage four pressure ulcer to her sacrum and had a colostomy. Review of the most recent care plan revealed Resident #93 had a pressure ulcer to her sacrum related to immobility. Interventions included to document treatments as ordered and follow the facility policies/protocols for prevention/treatment of skin breakdown. Additionally, if the resident refused the treatment, confer with the resident, interdisciplinary team (IDT) and family to determine why and document. Review of a physician order, dated 04/18/24, revealed to cleanse the wound to the sacrum with normal saline, pat dry, pack the wound with calcium alginate with silver and cover with a Mepilex (antimicrobial foam dressing) and change on every shift. Review of the Treatment Administration Record (TAR) dated 04/30/24 revealed Resident #93's wound care treatment was documented as completed on the night shift. Observation on 05/01/24 at 9:07 A.M. of Resident #93's wound dressing to the sacrum revealed the dressing was undated. Concurrent interview with Resident #93 revealed her dressing was not changed on 04/30/24. Resident #93 denied refusing wound care treatment. Interview on 05/01/24 at 10:05 A.M. with agency Licensed Practical Nurse (LPN) #131 confirmed she did not complete Resident #93's wound treatment on the night shift on 04/30/24. LPN #131 stated the resident refused the treatment but she did not document Resident #93 refused. LPN #131 verified she documented the treatment as completed even though it had not been done. (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: 365375 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 365375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowbrook Care Center 8211 Weller Road Cincinnati, OH 45242 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)