Health inspection·December 26, 2023

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 policy review, the facility failed to ensure a resident received treatment to a non-pressure related skin issue as ordered by the advanced level provider. This affected one resident (#5) of three residents reviewed for wounds. Residents Affected - Few Findings include: A review of Resident #5's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included heart failure, atherosclerotic heart disease (ASHD), peripheral vascular disease, major depressive disorder, and anxiety disorder. A review of Resident #5's care plans revealed she had an active care plan in place for a friction abrasion on her right great toe and left middle toe. The care plan was initiated on 11/25/23. The interventions included keeping the skin clean and dry and to monitor/ document the location, size, and treatment of skin injury. The interventions did not include the need to provide any treatments as ordered. A review of Resident #5's Skin Grid for Non-Pressure assessments dated 11/25/23 revealed the resident developed a non-pressure area to her right great toe on that date that measured 1 centimeters (cm) x 0.5 cm. The area was indicated to be scabbed. She also had a similar area to the second toe of her left foot that measured 1 cm x 0.5 cm. The summary of care and treatment for those assessments revealed the resident was seen by the wound nurse. The comments described the areas as blisters with signs and symptoms of an infection. Triple Antibiotic Ointment (TAO) was applied with dry gauze. She was to be seen by the wound nurse practitioner. Both areas were last assessed on 12/19/23 and were still present (as of 12/26/23). Both areas had shown signs of improvement despite the delay in treatment. A review of Resident #5's physician's orders revealed no treatment was ordered to the non-pressure areas to the right great toe and the second toe on the left foot until 12/12/23. The treatment ordered on 12/12/23 was for Dermasyn/ Hydrogel to be applied to the right great toe and the second toe of the left foot every day shift. A review of Resident #5's treatment administration records (TAR's) for November and December 2023 revealed no evidence of any treatment being provided to the areas on the right great toe and second toe on the left foot between 11/25/23 (date of origin) and 11/30/23. The TAR's for December 2023 revealed a treatment was not documented as having been provided to those non-pressure skin issues until 12/13/23 (17 days after the areas were first noted). Page 1 of 2 365696 365696 12/26/2023 Continuing Healthcare at Forest Hill 100 Reservoir Road St Clairsville, OH 43950

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/26/23 at 3:53 P.M., an interview with the Director of Nursing (DON) confirmed there was no documented evidence of a treatment being provided to the two non-pressure skin areas Resident #5 was found to have on her right great toe and second toe on the left foot on 11/25/23. She confirmed a treatment was not ordered to those areas until 12/12/23 and the TAR's revealed a treatment was not initiated until 12/13/23. She spoke with the facility's wound nurse and was informed the initial treatment order given by the wound nurse practitioner was a verbal order and was not followed through with. She stated the facility's wound nurse failed to enter it into the resident's orders resulting in the order not being carried over on the TAR's. The wound nurse told her the wound nurse practitioner then wanted the area left open to air on 12/05/23 that also did not get put into the physician's orders. The facility's wound nurse did not know the directive to leave the areas open to air required a physician's orders. It was not until 12/12/23 that another treatment order was given that was entered into the computer and made its way onto the TAR. That treatment was initiated on 12/13/23, after it was ordered. A review of the facility's wound management program (dated November 2021) revealed the facility was committed to providing a comprehensive wound management program to promote the resident's highest level of functioning and well-being. Any residents with wounds would receive treatment and services consistent with the resident's goals of treatment. The goal was one of promoting healing and minimizing infection. This deficiency represents non-compliance investigated under Complaint Number OH00149210. 365696 Page 2 of 2