Inspection·July 2, 2025

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 record review, staff interview, and review of facility policy, the facility failed to ensure the physician was updated regarding a wound change affecting Resident #10. The facility also failed to ensure wound treatments and assessments were obtained timely affecting two (#10, #13) of three reviewed for wounds. The facility census was 63.1.Review of medical record for Resident #10 revealed an admission date of 04/16/25. Diagnoses included malignant neoplasm of mouth, tracheostomy and gastrostomy tubes, and skin graft to the right forearm. The resident was discharged on 05/09/25 to the hospital and did not return.Review of the admission Minimum Data Set (MDS) dated [DATE] revealed a Brief Interview Mental Status (BIMS) score of 10 indicating impaired cognition. Resident #10 was dependent on eating and required maximum assistance for toileting hygiene, bed mobility and moderate assistance for transfers. Resident #10 was documented to be frequently incontinent of bowel and occasionally incontinent of urine and was noted to have a surgical wound. Review of Resident #10's care plan contained no reference to the resident having a surgical wound and contained no information regarding Resident #10's dressing changes.Review of the physician orders to start 04/19/25 revealed Resident #10's right forearm surgical graft site was to be cleansed daily with normal saline, covered with xeroform followed by a nonadherent surgical dressing and wrapped with rolled bandage. The right arm was then to be wrapped with a Coban wrap (an adherent wrap used to secure and protect primary dressing).Review of the weekly nurse skin assessments revealed Resident #10 had a surgical graft site to the right forearm, however the assessments contained no description of the graft site.Review of a wound assessment note completed by the wound nurse dated 05/02/25 revealed Resident #10 had a right forearm surgical skin graft, the wound measured 5.2 centimeters (cm) by 2.6 cm. The wound description stated the wound had a pink base with scattered slough.Review of the 05/08/25 hospital documentation revealed Resident #10 was sent to the Emergency Department (ED) for altered mental status changes. Resident #10 was documented as alert and oriented to person at the time of arrival in the ED. The ED assessment revealed a wound to the right forearm with purulent drainage. The right forearm wound was cleansed and redressed. Resident # 10 was given an oral antibiotic and returned to the nursing facility with an antibiotic prescription. The ED discharge summary revealed Resident #10 was diagnoses with cellulitis of the right arm and altered mental status changes.Interview on 07/01/25 at 1:32 P.M. with Wound Nurse Licensed Practical Nurse (WNLPN) #101 revealed she had been off on medical leave and had not assessed Resident #10's wound until 05/02/25. WNLPN #101 verified the right forearm wound had a pink base with scattered slough during her assessment. WNLPN #101 verified previous wound assessments completed by nursing contained measurements but no description of the wound. WNLPN #101 stated she had not communicated with the physician regarding her assessment of Resident #10's right forearm wound. Interview on 07/02/25 at 1:12 P.M. with the Director of Nursing (DON) revealed the facility wound physician had not seen Resident #10 and added, the wound physician had seen a limited number of residents because Residents Affected - Few (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 3 Event ID: 365532 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 365532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Greenville 243 Marion Drive Greenville, OH 45331 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)