Health inspection·April 30, 2024

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, record review, interview and facility policy review, the facility failed to ensure Resident #35's bilateral lower extremity non-pressure wound care was completed as ordered by the physician. This finding affected one resident (#35) of three residents reviewed for wounds. Residents Affected - Few Findings include: Review of the medical record revealed Resident #35 was readmitted on [DATE] with diagnoses including partial traumatic amputation of the left foot, sepsis, and chronic obstructive pulmonary disease. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #35 exhibited moderate cognitive impairment. Review of Resident #35's physician orders revealed an order dated 04/17/24 to cleanse the bilateral lower extremities with normal saline, apply collagen powder to the wound bed followed by Xeroform (non-adherent dressing) and cover with a four-by-four gauze and wrap with Kerlix gauze once every two days. Review of the Medication Administration Records (MARS) and Treatment Administration Records (TARS) from 04/01/24 to 04/30/24 revealed Licensed Practical Nurse (LPN) #811 documented she had completed Resident #35's bilateral lower extremity wound care on 04/27/24 and LPN #810 documented she had completed the resident's bilateral lower extremity wound care on 04/29/24. Review of the Skin Grid Non-Pressure form dated 04/23/24 revealed Resident #35 had a vascular left lower anterior leg wound which measured 11.1 cm (centimeters) length by 2.2 cm width by 0.1 cm depth. Review of the Skin Grid Non-Pressure form dated 04/23/24 revealed Resident #35 had a left posterior leg vascular ulcer which measured 6.1 cm length by 42 cm width by 0.1 cm depth. Review of the Skin Grid Non-Pressure form dated 04/23/24 revealed Resident #35 had a right anterior lower leg vascular wound which measured 10.5 cm length by 4.4 cm width by 0.1 cm depth. Observation on 04/30/24 at 6:21 A.M. with LPN Nightshift Supervisor #804 of Resident #35's bilateral lower extremity wound care dressings revealed the bilateral dressings were dated 04/27/24. Interview on 04/30/24 at 6:25 A.M. with LPN Nightshift Supervisor #804 confirmed Resident #35's bilateral lower wound care dressings were not completed as ordered. Page 1 of 2 365520 365520 04/30/2024 Phoenix of Maple Heights 19900 Clare Ave Maple Heights, OH 44137

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 04/30/24 at 6:43 A.M. of LPN #801 with LPN Nightshift Supervisor #804 in attendance confirmed Resident #35's bilateral lower extremity wound care was to be completed every two days and was signed off as completed on both 04/27/24 by LPN #811 and 04/29/24 by LPN #810. Review of the Clean Dressing Change Policy revealed to wash hands, remove soiled dressing and discard in a plastic bag, apply a dressing, wash hands, and document in the medical record. This deficiency represents non-compliance investigated under Complaint Number OH00152966. 365520 Page 2 of 2