Health inspection·June 21, 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 closed medical record review, policy review, and interview the facility failed to implement wound care orders for former Resident #49. This affected one resident (#49) of three residents reviewed for skin impairments. Residents Affected - Few Findings include: Review of the closed medical record for former Resident #49 revealed an admission date of 08/18/22, discharge date of 06/15/23 with diagnoses of paraplegia, complete lesion at C5 level spinal cord, autonomic dysreflexia, and neurogenic bladder. Review of the skin alteration incident report dated 05/08/23 revealed during resident care, this nurse observed a skin alteration to resident's right heel. Effected area had discoloration and peeling skin. Review of the skin grid non-pressure assessment dated [DATE] revealed Resident #49 had a new non-pressure area to the right heel described as a red area with chapped skin and bruising measuring 3.0 centimeters (cm) by 3.0 cm. The surrounding tissue/wound edges were normal and there was no exudate. Resident #49 had current treatment order to pad and protect. Review of the general note dated 05/09/23, timed 10:06 A.M. revealed the wound physician was at Resident #49's bedside to evaluate and treat. New orders for skin treatment were received. Review of Physician #16's wound assessment and plan dated 05/10/23 revealed Resident #49 had a skin tear to the right posterior heel measuring 0.3 cm by 0.2 cm secondary to right lower extremity spasm and striking wheelchair. Physician #16 ordered medical honey (Medihoney) gel Xeroform, clean wound with normal saline or sterile water, apply to wound bed, cover with dry clean dressing daily and as instructed, offload pressure/float foot on pillow while in bed (may also use Prevalon style boot) and a daily multivitamin. Review of the physician orders from May 2023 revealed Resident #49 had an order to pad and protect right heel with bordered foam and change per the resident's request as needed. There was no evidence Physician #16's orders were transcribed in the physician orders in the electronic medical record (EMR) including the Medihoney daily wound care, floating foot on pillow, or the daily multivitamin. Review of the skin grid non-pressure assessment dated [DATE] revealed Resident #49's right heel skin tear had deteriorated showing a moderate amount of exudate of serosanguineous drainage, and there was maceration of the surrounding tissue/wound edges. Resident #49 was seen by the wound physician during wound rounds. Area caused by right lower extremity spasm and causing area to strike Page 1 of 2 365834 365834 06/21/2023 Majestic Care of Kent 1290 Fairchild Avenue Kent, OH 44240

F 0684 Level of Harm - Minimal harm or potential for actual harm wheelchair. The area had deteriorated. The resident stated to the nurse and physician that he had refused to allow the Medihoney (medical honey) to be applied during dressing changes. Review of Physician #16's wound assessment and plan dated 05/17/23 revealed Resident #49's right heel skin tear had declined and was measuring 1.5 cm by 2.0 cm. Residents Affected - Few Review of the pressure ulcer care plan updated 05/17/23 revealed Resident #49 had potential for pressure ulcer development related to immobility and had a skin tear to his right posterior heel with interventions to administer treatments as ordered. Review of the May 2023 Medication Administration Record (MAR) and Treatment Administration Record (TAR) revealed the pad and protect to the right heel was not implemented/completed on 05/08/23 or 05/09/23. The physician order of medical honey gel Xeroform, clean wound with normal saline or sterile water, apply to wound bed, cover with dry clean dressing daily and as instructed, offload pressure/float foot on pillow while in bed (may also use Prevalon style boot) were not listed in the MAR or TAR from 05/10/23 through 05/16/23 for the resident to refuse the orders. The daily multivitamin was not administered at all during May 2023. Review of the June 2023 MAR revealed the daily multivitamin was not administered at all during June 2023. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #49 was cognitively intact, needed physical extensive assistance of two-person for transfers, bed mobility and dressing and had a skin tear. Interview on 06/21/23 at 11:40 A.M. with Resident #49 revealed he still had a wound on his right heel. Interview on 06/21/23 at 4:00 P.M. with the Director of Nursing (DON) verified Resident #49 did not receive the pad and protect on the right heel on 05/08/23 or 05/09/23 and verified Physician #16's orders were not transcribed into the EMR so Resident #49 did not receive nor was offered the Medihoney daily wound care from 05/10/23 through 05/16/23. A follow-up interview on 06/21/23 at 4:40 P.M. with the DON verified Resident #49 was not administered the daily multivitamin during May 2023 or June 2023. Review of the facility's wound management program policy dated November 2021 revealed any resident with wounds receives treatment and services consistent with the resident's goals of treatment. Orders were verified and obtained as needed. This deficiency represents non-compliance investigated under Complaint Number OH00143397. 365834 Page 2 of 2