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).
(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:
365696
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
365696
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Continuing Healthcare at Forest Hill
100 Reservoir Road
St Clairsville, OH 43950
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)
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.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365696
If continuation sheet
Page 2 of 2
