Health inspection·February 17, 2026

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 record review, interview, and policy review, the facility failed to ensure physician orders were followed regarding wound care. This affected one (#33) of three residents reviewed for wounds. The facility census was 32.Findings include:Review of medical record for Resident #33 revealed an admission date of 12/05/25 and discharge date of 01/07/26 with diagnoses including but not limited to atrial fibrillation, psoas muscle abscess, heart failure, chronic gout, bacteremia, osteomyelitis of vertebra lumbar region, neoplasm of uncertain behavior of cerebral meninges, type two diabetes, non-pressure chronic ulcer of other part of right foot with fat layer exposed and hypertension.Review of minimum data set (MDS) dated [DATE] revealed the resident was cognitively intact.Review of physician orders revealed treatment to coccyx triad cream with optifoam daily ordered from 12/06/25 through 12/12/25, sacrum wound cleanse with normal saline (NS) apply Santyl nickel thick, calcium alginate and apply silicone border foam dressing from 12/12/25 through 12/19/25, and mid thoracic back wound treatment cleanse with NS, apply silver alginate cover with ABD and secure with tape daily from 12/12/25 through 12/24/25, back incision cleanse with NS cover with gauze and ABD pad secure with tape daily from 12/06/25 through 12/10/25, sacrum wound cleanse with NS apply Santyl nickel thick, calcium alginate, xtrasorb and cover with tape daily from 12/20/25 through 12/24/25, miconazole external powder two percent (%) apply to affected skin areas topically twice daily for skin rash, bilateral heels apply derma prep and cover with mepilex every three days from (12/09/25 through/ 12/24/25, and right heel wound cleanse with NS apply skin prep and cover with silicone bordered foam dressing on Tuesday, Thursday, and Saturday daily.Review of treatment administration record (TAR) for December 2025 revealed the treatment to coccyx triad cream cover with optifoam was not signed off on 12/11/25, treatment to sacrum was not signed off for 12/16/25, mid thoracic back wound treatment was not signed off on 12/16/25 and 12/18/25, miconazole external powder two % twice daily was not signed off at bedtime on 12/11/25 and 12/12/25 and upon rising on 12/16/25, right heel wound cleanse with NS apply skin prep and cover with silicone bordered foam dressing on Tuesday, Thursday, Saturday was not signed off on 12/16/25, back incision cleanse with NS cover with gauze and ABD pads secure with tape daily was not signed off on 12/11/25, and bilateral heels apply derma prep and cover with mepilex every three days was not signed off on 12/11/25.Review of after visit summary dated 01/03/26 revealed orders to pack coccyx wound with Dakin's soaked kerlix and then apply sacral foam border to hold in place, paint bilateral heels with iodine and place mepilex over unstageable wounds daily, and back incision dressing check operative dressing at least once a shift and change dressings postoperative day three and then as needed moving forward. Postoperative day three is 01/05/26.Review of physician orders for January 2026 revealed heel inspection twice daily from 01/03/25 through 01/08/26, Dakin's soaked kerlix one quarter strength to sacral wound daily from 01/07/26 through 01/20/26, left heel paint with betadine cover with mepilex daily start date of 01/08/26 and discharge date of 01/08/26. No order was noted for monitoring the back Residents Affected - Few (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 3 Event ID: 365860 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 365860 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/17/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Independence House 1000 Independence Rd Fostoria, OH 44830 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)