Health inspection·January 31, 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 medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to implement interventions as ordered by the physician. This affected two (#2 and #4) of 12 residents reviewed for physician-ordered interventions. The facility census was 45. Residents Affected - Few Findings include: 1. Review of Resident #2's medical record revealed an admission date of 06/23/23. Diagnoses included acute kidney failure, dysphagia, congestive heart failure, myocardial infarction, peripheral vascular disease, and a history of pulmonary emboli. Review of Resident #2's physician orders revealed and order dated 09/04/23 for compression stockings to be applied in the morning and removed at bedtime. Observations on 01/30/24 at 3:25 P.M. and on 01/31/24 at 10:10 A.M. revealed Resident #2 was not wearing compression stockings. Interview with the Director of Nursing (DON) on 01/31/24 at 10:10 A.M. verified Resident #2 failed to have compression stockings applied as ordered. Interview with Resident #2 on 01/31/24 at 10:11 A.M. stated she never had compression stockings applied and she was not aware there was an order for them. Review of Resident #2's medication administration records (MAR) and treatment administration records (TARs) dated 09/04/23 through 01/31/24 revealed no reflection of the physician order to apply the compression stockings which resulted in no documentation of the task being completed. 2. Review of the medical record revealed Resident #4 was admitted to the facility on [DATE]. Diagnoses included congenital malformation syndromes, cerebral palsy, hereditary and idiopathic neuropathy, and dysphagia. Review of the annual Minimum Data Set (MDS) 3.0 assessment, dated 10/26/23, revealed Resident #4 was severely cognitively impaired. The resident required assistance from staff for all activities of daily living, including upper and lower body dressing and for putting on and taking off footwear. Review of Resident #4's current physician orders for January 2024 revealed an order to apply Tubigrips (elasticated tubular support bandages) to the lower legs to prevent bruising. The order had a start date of 09/24/23. (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 6 Event ID: 365656 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 365656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of New London The 204 W Main St New London, OH 44851 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)