Inspection·September 11, 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 medical record reviews, staff interview, and policy review, the facility failed to complete wound assessments at the time of admission and/or failed to timely initiate treatment for wounds. This affected two (#16 and #32) out of three residents reviewed for wounds. The facility census was 75. Findings include: 1.Review of the medical record for Resident #16 revealed an admission date of 05/23/25 with medical diagnoses of aftercare following surgical amputation, peripheral vascular disease, end stage renal disease, and diabetes mellitus (DM). Review of a quarterly Minimum Data Set (MDS) assessment, dated 08/16/25, indicated Resident #16 was cognitively intact and required substantial/maximum staff assistance for toilet hygiene and bathing, partial/moderate staff assistance for bed mobility and was dependent upon staff for transfers. The MDS indicated Resident #16 admitted with two deep tissue injuries (DTI), DM foot ulcer, and surgical wound. Review of a nursing comprehensive assessment, dated 05/23/25, indicated under the skin assessment that Resident #16 had right toe amputation, redness to bilateral buttocks, coccyx, and heels. The assessment did not contain documentation to support measurements or description of skin issues. Review of wound/skin evaluations completed 05/28/25 indicated Resident #16 admitted with a vasculitic injury to left dorsum fifth digit (toe) which measured 2.0 centimeters (cm) by 1.8 cm with 20% slough and 50% eschar, a vasculitic injury to left heel which measured 4.2 cm by 3.2 cm and had 100% eschar, an other skin issue to right lateral malleolus which measured 3.0 cm by 2.5 cm with 100% eschar, a DTI to right heel which measured 5.2 cm by 3.8 cm with 100% eschar, an other skin issue to left lateral malleolus which measured 1.6 cm by 1.2 cm with 100% eschar, a surgical site to right dorsum first digit with partial dehiscence which measured 8.7 cm by 3.6 cm, an other skin issue to right dorsum foot which measured 1.9 cm by 1.3 cm, an other skin issue to left lateral midfoot which measured 2.1 cm by 1.9 cm and moisture associated skin damage (MASD) to sacrum with no measurements noted. Review of the physician orders for Resident #16 revealed no documentation to support treatment was initiated for the above wounds until 05/29/25. Review of medical record for Resident #16 revealed documentation to support Resident #16 was seen by a wound physician weekly starting 06/03/25 until discharged on 06/27/25. Review of the wound physician note dated 06/24/25 indicated Resident #16 had a DTI ulcer to left heel, unstageable pressure ulcer to right anterior ankle (formerly documented as right lateral malleolus), a surgical wound to right distal foot, an unstageable pressure ulcer to right dorsal foot, and a DTI to right heel. Interview on 09/11/25 at 10:45 A.M. with Licensed Practical Nurse (LPN) #203 confirmed the medical record for Resident #16 did not have documentation to support the wounds were evaluated upon admission on [DATE] until 05/28/25 and that a treatment for the wounds was not initiated until 05/29/25. 2. Review of the medical record for Resident #32 revealed an admission date of 07/17/25 with medical diagnoses of diabetes mellitus with foot ulcer, chronic ulcer of left heel and midfoot with fat layer exposed, congestive heart failure, anemia, and atrial fibrillation. Review of the admission MDS assessment, dated 07/24/25, 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 4 Event ID: 365627 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 365627 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Huber Heights The 5440 Charlesgate Road Huber Heights, OH 45424 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)