Inspection·July 15, 2025

F 0684 Level of Harm - Actual harm Residents Affected - Few multiple aggressive debridement's concerning of necrotizing fasciitis. The resident was evaluated by wound care and a wound vacuum (vac) was reapplied. The resident's skin was normal with a normal temperature and left arm fistula. The skin impairment to the right ring finger was not identified on the form.Review of Resident #10's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition.Review of Resident #10's Nursing Skin Tool dated 06/20/25 revealed no changes to the previous areas and no new areas. The skin impairment to the right ring finger was not identified on the form.Review of Resident #10's Physician Note form dated 06/20/25 authored by Therapy Physician #914 revealed an initial consultation to evaluate skilled therapy services. The resident was admitted to the hospital with a three-day history of fever, weakness, and severe peritoneal pain with a fall. The resident was found to have necrotizing fasciitis of the left groin and underwent surgical debridement on 06/02/25 and again on 06/05/25. The resident's skin was thin with bruising, a fistula in the right arm with a good pulse and thrill. The skin impairment to the right ring finger was not identified on the form.Review of Resident #10's physician progress note dated 06/26/25 authored by Covering Physician #915 revealed the resident's skin had a normal temperature and a left arm fistula with no abnormal bruising.Review of Resident #10's Nursing Skin Tool dated 06/27/25 revealed no changes and no new areas noted. The skin impairment to the right ring finger was not identified on the form.Review of Resident #10's Nursing Assistant Bathing/Skin Tool dated 07/01/25 revealed the resident received a shower. Written documentation on the form indicated no new concerns were identified. The skin impairment to the right ring finger was not identified on the form.Review of Resident #10's progress note dated 07/01/25 at 2:47 P.M. revealed Resident #10 had a colonoscopy scheduled for 07/02/25 at 6:45 A.M.Review of Resident #10's hospital admission paperwork dated 07/02/25 revealed the resident was recently hospitalized from [DATE] to 06/12/25 for management of a groin abscess and the concern for necrotizing fasciitis, he was discharged to a skilled nursing facility with a wound vac. The resident presented to the emergency room (ER) today with a concern for a right fourth digit necrosis and lower extremity wounds. The resident's finger had reportedly been turning black and associated with pain with any kind of movement for the past few days. He also had several ulcerated lesions on his toes bilaterally and was supposed to be scheduled for a follow-up with podiatry, but had not been seen yet. The x-ray of the hand demonstrated lucency under the nailbed of the fourth digit likely related to an infection.Review of hospital emergency room documentation dated 07/02/25 at 4:29 P.M. revealed Resident #10's right ring finger nailbed and tip of the finger appeared black. Photos were included in the documentation which showed the tip of the right ring finger appeared black with flaking, peeling skin at the tip, with a small uneven portion of the tip of the finger missing underneath the fingernail. The hospital documentation noted on 07/02/25, the resident had a revision amputation of the right fourth finger by orthopedic surgery. Per orthopedic surgery, the distal phalanx bone was felt to be of good strength, but a large portion of the phalanx was debrided due to the level of skin necrosis.Review of Resident #10's Operative Report dated 07/03/25 at 11:28 A.M. revealed the resident presented with necrosis of the right ring finger which had worsening surrounding erythema and pain. The resident was offered formal irrigation and debridement in the operating room with revision amputation to achieve adequate soft tissue closure. The distal phalanx bone was felt to be of good strength atypical of osteomyelitis but due to the level of skin necrosis, a large portion of the phalanx was debrided and sent for specimen.Review of the hospital Nephrology Service note dated 07/03/25 at 1:57 P.M. revealed Resident #10, who received dialysis was admitted with right ring finger necrosis with worsening pain and redness. He was status post revision amputation of the finger earlier in the morning.Interview on 07/10/25 at 4:55 A.M. with RN #804 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365482 If continuation sheet Page 2 of 3 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 365482 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Navarre Ctr for Rehab & Nrsg Care 517 Park Street NW Navarre, OH 44662 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)

F 0684 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated staff sometimes did not do what they were supposed to do in terms of wound care, but she would not specify. RN #804 revealed (on 07/02/25) Resident #10 had gone for a colonoscopy and the hospital staff had identified the resident had a necrotic finger. The resident was then admitted to the hospital. Interview on 07/10/25 at 6:28 A.M. with Licensed Practical Nurse (LPN) Wound Nurse (WN) #809 revealed Resident #10 had a bruised, dark finger. She denied the resident had a surgical consultation for the finger and denied knowledge of the area looking necrotic. Interview on 07/10/25 at 7:40 A.M. with the Director of Nursing (DON) revealed Resident #10's right finger was bruised but stated the staff did not notice necrotic tissue.Telephone interview on 07/10/25 at 7:54 A.M. with RN #812 revealed Resident #10 was admitted to the facility with an open area to the left groin and some areas on the left and right feet as well as left and right hands. She stated she could not remember exactly what the wounds looked like, including the areas on the resident's hands.Interview on 07/10/25 at 9:44 A.M. with Dialysis RN #910 revealed she had provided care to Resident #10 on several occasions and did not observe necrosis on the resident's fingers.Interview on 07/10/25 at 9:52 A.M. with Certified Occupational Therapy Assistant (COTA) #911 revealed Resident #10 had some blackness and scaling on his right ring finger but she could not tell if it was a bruise or not. She stated that it was not within her scope of practice to assess the area. COTA #911 did not disclose if she notified any nursing staff regarding the resident's black scaly right ring finger. Interview on 07/10/25 at 9:55 A.M. with LPN #912 revealed Resident #10's right ring finger looked dark but denied knowledge of it being weeping or open. LPN #912 indicated the ring finger did not look necrotic to her knowledge.Interview on 07/10/25 at 11:25 A.M. with Physician #913 revealed he assessed Resident #10 on 06/16/25 and did not identify concerns with the resident's right ring finger or necrosis. Physician #913 also stated Physician #914 assessed the resident on 06/20/25 and Physician #915 assessed the resident on 06/26/25 and no one had identified any type of necrotic areas on the resident's hands during those visits. The resident was transported to the hospital related to the condition of his finger on 07/02/25 (six days after last being seen by a physician).Interview on 07/10/25 at 1:08 P.M. with RN Regional #909 revealed nursing staff were to complete a whole-body assessment once weekly. The Rn revealed facility staff did not document bruises on the form unless there was a change in the bruise. If the bruise worsened, it would be reassessed and reported to the physician for further orders. RN Regional #909 confirmed the documentation for Resident #10 did not have evidence the right ring finger was assessed for improving or worsening of the skin impairment.Telephone interview on 07/14/25 at 11:48 A.M. with Resident #10's family member revealed the resident's right finger started turning dark in May 2025. The family member stated the resident had been admitted to the hospital on two separate occasions and the hospital was monitoring the finger. Resident #10's family member revealed the resident had reported pain to the nursing staff during his stay (date not provided) and was told the right ring finger was just bruised. She indicated when the resident was sent to the hospital for the colonoscopy (on 07/02/25) it was determined the right ring finger was necrotic and the resident had to have surgery to remove the necrosis. Review of the undated Wound Care policy revealed it was the facility policy to provide guidelines for the care of wounds to promote healing.This deficiency represents non-compliance investigated under Complaint Number OH00167473 (1367059). Event ID: Facility ID: 365482 If continuation sheet Page 3 of 3