Health inspection·May 19, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 and interview, the facility failed to ensure wound treatments were competed per physician orders for Resident #24. This effected one resident (Resident #24) out of three residents reviewed for wound care. The facility census was 42. Residents Affected - Few Findings include: Review of the medical record for Resident #24 revealed an admission date of 12/05/22 with diagnoses including sepsis, orthostatic hypotension, anemia, dysphagia, type two diabetes mellitus, sacral wound, dementia, chronic kidney disease, and spinal stenosis of the lumbar region. Review of Resident #24's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had severely impaired cognition. They required partial to moderate assistance with eating and upper body dressing. They required substantial to maximal assistance with oral hygiene, personal hygiene, and bed mobility. Additionally, they were dependent on staff for showers, toileting hygiene, bed mobility and transfers with a full lift by two staff members. Review of Resident #24's care plan indicated 03/10/25 the resident had an unstageable pressure ulcer to her sacrum. The resident was at risk for pressure ulcers related to incontinence, poor skin integrity, lumbar stenosis, rediculopathy, constipation, hypertension, weakness and chronic kidney disease. Goals and interventions included reduction of the risk for skin breakdown over the next 90 days, assess and monitor for additional skin breakdown and report to the physician, turn and reposition at a minimum of every two hours, suspend heels off bed surface with pillow under lower legs, wound care per physician orders, and pressure reduction measures to wheelchair and bed. Review of Resident #24's physician orders dated May 2025 revealed the resident was to be turned and repositioned every two hours and as needed every shift, pressure redistribution pad in wheelchair every shift, air mattress to bed every shift, and cleanse site to buttocks with normal sterile saline (NSS), apply Santyl ointment nickel thickness to wound bed and loosely pack with moistened NSS kerlix gauze and cover with an abdominal dressing daily and as needed. Review of Resident #24's Treatment Administration Record (TAR) for May 2025 revealed all treatments had been initialed as completed per physician orders. Observation on 05/14/25 at 10:20 A.M. of wound care for Resident #24 by Licensed Practical Nurse (LPN) #800 with assistance from Certified Nursing Assistant (CNA) #805 revealed the dressing on Resident #24's buttocks was dated 05/12/25. LPN #800 proceeded to remove this dressing and provide wound care per physician orders and followed appropriate infection control procedures. LPN #800 stated (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 4 Event ID: 365580 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 365580 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shepherd of the Valley-Boardman 7148 West Blvd Youngstown, OH 44512 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)