Health inspection·February 25, 2025

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 observation, staff interview, resident interview and review of facility policy, the facility failed to ensure treatments for pressure wounds were completed as physician ordered. This affected one (#52) of three residents reviewed for wound care. The facility census was 74. Residents Affected - Few Findings include: Review of medical record for Resident #52 revealed admission date of 11/10/23. Diagnoses included quadriplegia, pressure ulcer of the left heel, stage four pressure ulcer of the sacral and pressure induced deep tissue damage of right the buttocks. Review of the Minimum Data Set (MDS) assessment, dated 01/31/25, revealed Resident #52 had a Brief Interview of Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. Further review revealed Resident #52 had bilateral impairment to the upper and lower extremities and was staff dependent on all activities of daily living (ADLs). Additionally, Resident #52 had two stage three pressure ulcers and five stage four pressure ulcers. Review of Resident #52's care plan, dated 01/27/25, revealed the resident had non-compliance related to wound care treatments and side to side positioning in bed. Further review revealed on 01/14/25, the resident stated wound care was not completed by staff; however, the resident was refusing at times wound care treatment was to be provided. The interventions included educational attempts made with residents and family related to non-compliance and notifying the physician of non-compliance. Additional review of the care plan revealed Resident #52 had stage four pressure ulcers to the coccyx related to immobility, paraplegia and weakness. The interventions included wound care treatments as ordered, monitoring dressing to ensure it was intact and adhering and report loose dressing to the nurse. Review of Resident #52's current physician orders revealed treatment for the sacrum and bilateral ischium wounds included to cleanse with saline or antibacterial soap and water, pack wounds with Vashe moistened kerlix, apply abdominal pad and secure with Mefix or silicone tape or alternative, every night shift for wound care. Review of the Treatment Administration Record (TAR) for February 2025 revealed the treatment for the sacrum and bilateral ischium was not documented as completed on 02/02/25, 02/03/25, 02/07/25, 02/08/25, 02/17/25, 02/20/25, 02/23/25 and 02/24/ 25. Review of the nursing progress notes revealed no evidence Resident #52 refused these wound treatments. Observation on 02/25/25 at 7:05 A.M. of wound treatment for Resident #52, completed by Licensed Practical Nurse (LPN) #225 and Certified Nurse Aide (CNA) #140 revealed the dressing on the wound was (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 2 Event ID: 365453 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 365453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Oregon 3953 Navarre Ave Oregon, OH 43616 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)