Health inspection·January 17, 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, observations, staff interview, and policy review, the facility failed to ensure wound dressings were changed in a clean and sanitary manner. This affected two (#56 and #36) of three residents reviewed for wound care. The census was 86. Residents Affected - Few Findings include: 1. Record review revealed Resident #36 was admitted to the facility on [DATE] with diagnoses of unspecified thoracic thoracolumbar and lumbosacral intervertebral disc disorder, cervical disc disorder with myelopathy, unspecified cervical region, dorsalgia, unspecified, and osteomyelitis of vertebra, lumbar region. with diagnoses of Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed a Brief Interview for Mental Status (BIMS) Score of 15 out of 15 indicating the resident was cognitively intact. Review of the care plan dated 12/16/23 revealed Resident #36 had impaired skin integrity. Interventions included Resident #36 will comply with recommendations/treatments to minimize further skin impairment, will show signs of healing and/or improvement to the extent allowed by the resident's age, mobility status, continence status, medication and/or treatment compliance, medical condition and/or comorbidities, and compliance with wound care recommendations, identified skin impairment will be free of signs and symptoms of infection, treatment(s) per physician orders and wound consult as needed (PRN). Observation on 01/17/24 at 9:51 A.M. with Registered Nurse (RN) #37, Wound Nurse revealed dressing change on Resident #36 with dressing change to spine and right lateral ankle. Resident #36 was observed in isolation, RN #37 gowned and gloved up prior to entering room. All supplies brought into room. Dressing removed to spine, spine wound cleansed with Vashe wound cleanser and four by four (4x4) pad, calcium alginate applied and covered with adhesive dressing. Gloves were removed, hands sanitizer used to clean hands and clean gloves applied. Ankle wound dressing removed, wound cleansed with Vashe wound cleanser and 4x4, betadine applied to wound with large swab and covered with adhesive dressing. Gloves and gown removed. Hands washed prior to leaving room. Interview on 01/17/24 at 10:00 A.M. with RN #37 confirmed she did not change her gloves during a dressing change on Resident #36 after removing the dirty dressing and before cleaning the wound and applying a clean dressing. 2. Record review revealed Resident #56 was re-admitted to the facility on [DATE] with diagnoses of acute pancreatitis without necrosis or infection, unspecified, acquired absence of right leg below Page 1 of 2 365897 365897 01/17/2024 New Lebanon Rehabilitation and Healthcare Center 101 Mills Place New Lebanon, OH 45345

F 0684 knee, and type 2 diabetes mellitus with other skin complications. Level of Harm - Minimal harm or potential for actual harm Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15 indicating the resident was cognitively intact. Residents Affected - Few Review of the care plan dated 02/22/23 revealed Resident #56 had impaired skin integrity. Interventions included treatment(s) per physician orders, wound consult as needed (PRN) and identified skin impairment will be free of signs and symptoms of infection through the next review. Observation on 01/17/24 at 10:18 A.M. with RN #37, Wound Nurse revealed dressing change on Resident #56 to right knee stump. RN #37 knocked and introduced self, applied clean gloves, removed the dressing to right knee stump, cleansed the wound with Vashe wound cleanser and a 4x4 pad, applied collagen to open wound and covered with adhesive dressing. RN #37 removed her gloves and washed her hands. Interview on 01/17/24 at 10:36 A.M. with RN #37 confirmed she did not change her gloves during a dressing change on Resident #56 after removing the dirty dressing and before cleaning the wound and applying a clean dressing. Review of the facility policy Wound Care Policy dated September 2021 revealed Step 4 in the Steps in the Procedure revealed Put on exam glove. Loosen tape and remove dressing. If using scissors - ensure you clean the scissors before use. Step 5 in the Steps in the Procedure revealed Pull glove over dressing and discard into appropriate receptacle. Wash and dry hands thoroughly. Step 6 in the Steps in the Procedure revealed Put on gloves. Step 7 in the Steps in the Procedure revealed Clean wound and apply treatment as ordered by the physician. This deficiency represents non-compliance investigated under Complaint Number OH00149462. 365897 Page 2 of 2