Inspection·November 27, 2024

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 medical record review, observation, resident interview, and staff interview, the facility failed to clarify and implement a physician order. This affected one (#70) of three residents reviewed for wound care. The facility census was 76. Residents Affected - Few Findings include: Review of the medical record review revealed Resident #70 was admitted on [DATE]. Diagnoses included fracture of unspecified part of neck of right femur, hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease, unspecified osteoarthritis, essential hypertension, and polymyalgia. Review of the Minimum Data Set (MDS) assessment, dated 10/29/24, revealed the resident was cognitively intact and required substantial assistance with toileting, showers, and upper/lower body dressing. Resident #70 was occasionally incontinent of bladder and frequently incontinent with bowel. Resident #70 had a surgical wound. Review of the most recent care plan revealed Resident #70 had a deep tissue injury to the left heel and wound on the right hip. Interventions included to provide wound care treatment per physician order. Review of physician order, dated 11/12/24 and 11/13/24, revealed an order for the right hip wound. The order read: Keep clean and dry. Apply non prescriber adherent dressing daily. Monitor for warmth, redness, increased swelling or pain. Notify medical doctor if signs or symptoms of infection occur. Every 24 hours as needed for drainage. Review of the hand-written physician order, dated 11/12/24, revealed the right hip wound was slow to heal. Non-adherent bandage as needed for drainage, may leave open to air. Review of the Treatment Administration Review (TAR), dated November 2024, revealed the order was categorized as a as needed (PRN) order. Review of the TAR verified Resident #70 had a right hip wound dressing changed one time on 11/24/24. Interview on 11/26/24 at 9:00 A.M. with Resident #70 revealed the wound dressing for the surgical wound on her right hip does not always get changed like it should. Observation on 11/26/24 at 9:07 A.M. of Resident #70's right hip wound dressing revealed the dressing was dated 11/23/24. (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: 365896 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 365896 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fox Run Manor 11745 Township Road 145 Findlay, OH 45840 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)