Inspection·January 4, 2024

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 medical record review, staff interview, and review of facility policy, the facility failed to ensure wound care was completed per physician orders. This affected one (#10) of three residents reviewed for wound care. The facility census was 46. Residents Affected - Few Findings Include: Review of resident #10's medical record revealed and admission date of 01/23/18. Diagnoses included hemiplegia and hemiparesis following cerebral infarction affecting left non dominant side, cardiomyopathy, chronic systolic congestive heart failure, hypertension, osteoarthritis of knee, abnormalities of gait and mobility, weakness, and atrial fibrillation with long term use of anticoagulants. Resident #10 was discharged to the hospital on [DATE] per her request. Review of the discharge, return anticipated Minimum Data Set (MDS) assessment, dated 12/08/23, revealed Resident #10 had one facility acquired, unstageable pressure ulcer. Review of a Certified Nurse Practitioner (CNP) wound progress note, dated 08/08/23, revealed Resident #10 had a new right heel pressure wound, measuring 5.5 centimeters (cm) length by 7.5 cm width, with dark brown to black eschar covering the wound bed. Wound edges were pink and no wound drainage was noted. The note indicated the wound was caused by a brace/boot ordered by the orthopedic physician following an ankle fracture while out with family on 06/17/23. Review of Resident #10's right heel wound treatment orders revealed the following: • From 08/08/23 to 09/09/23, apply clean dry dressing to the right heel then wrap with gauze at bedtime. • From 08/09/23 to 11/27/23, apply Marathon (skin protectant) to right heel every 72 hours. • From 09/13/23 to 10/11/23, cleanse right heal with normal saline, apply betadine to the edge and apply foam dressing every day. Do not wrap with Kerlix (gauze roll). (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 2 Event ID: 365676 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 365676 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delaware Court Health Care Center 4 New Market Dr Delaware, OH 43015 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)