Inspection·October 27, 2022

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 observation, staff interview, record review and review of facility policy, the facility failed to provide wound care treatment as ordered for a resident with wounds. This affected one Resident (#78) out of two Residents (#78 and #7) observed for wound care. The facility identified four Residents (#7, #30, #32 and #78) with wounds and who required interventions for wound care. The facility census was 84. Residents Affected - Few Findings include: Review of Resident #78's medical records revealed an admission date of 01/12/22. Diagnosis included cerebral vascular attack (CVA/stroke) with right sided weakness, diabetes, and muscle weakness. Review of Minimum Data Set (MDS) dated [DATE] revealed resident had impaired cognition as well as depression. Review of care plan dated 10/06/22 revealed Resident #78 at risk for skin breakdown related to decreased mobility. Interventions included apply treatments per physician orders, encourage Prevalon boots (pressure reducing boots) while in bed and float heels if resident refuses. Review of physician orders for Resident #78 dated 10/05/22 revealed resident was ordered to receive skin prep (protective film) applied to right heel and to be covered with an absorbent dressing and gauze placed every Monday, Wednesday, and Friday. Review of Treatment Administration Record (TAR) for October 2022 revealed treatments had been documented as being completed. Observation of wound care on 10/26/22 at 10:13 A.M. for Resident #78 with Licensed Practical Nurse (LPN) #862, Assistant Director of Nursing (ADON) #865 and Wound Nurse Practitioner (NP) #928 revealed resident had an undated gauze dressing to his right leg. NP #928 had proceeded to remove the gauze and observation revealed resident had an open area to the outer portion of his right heel. NP #928 stated the area must have opened recently due to not being opened when she last assessed resident one week ago. NP #928 further stated the orders were for Resident to have an absorbent dressing to the right heel and then wrap the leg with gauze. ADON #865 and NP #928 confirmed there was no absorbent dressing on the resident's heel as ordered. Review of facility policy titled Dressing Change Policy and Procedure undated, revealed to apply dressings as ordered. 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: 365508 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 365508 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Welcome Nursing Home 417 South Main Street Oberlin, OH 44074 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)