Health 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. Page 1 of 2 365508 365508 10/27/2022 Welcome Nursing Home 417 South Main Street Oberlin, OH 44074

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and staff interview the facility failed to maintain a sanitary ice machine. This affected all residents except Residents (#3, #4, #27, #34, #75, #77 and #80) who received nectar like fluids and Residents (#40 and #42) who received no nourishment by mouth. The census was 84 residents. Findings Include: Observations on 10/25/22 at 2:50 P.M. revealed black fuzzy substance located on the upper inside frame of the ice machine. This ice machine was in the hall on the unit. Staff used the machine to provide fresh drinks to the residents. Interview on 10/25/22 at 2:56 P.M., the Administrator and Director of Nursing verified that black fuzzy substance identified on the upper frame above the available ice. Interview on 10/25/22 at 3:23 P.M., the Maintenance Director stated he completed general cleaning every Monday and completed deep cleaning once a month. Review of staff signature page for cleaning revealed the ice machine was cleaned on 10/17/22. 365508 Page 2 of 2