Health inspection·July 8, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and staff interviews, the facility failed to provide nail and skin care for Resident #3, who was dependent on staff for personal hygiene. This affected one (Resident #3) out of three residents reviewed for activities of daily living (ADL). The facility census was 59. Residents Affected - Few Findings include: Review of the medical record revealed Resident #3 was admitted on [DATE]. Diagnoses included anoxic brain damage, chronic obstructive pulmonary disease, metabolic encephalopathy, history of transient ischemic attack, attention deficit hyperactivity disorder, and chronic kidney disease. Review of the plan of care dated 04/11/24 revealed Resident #3 had an ADL self-care performance deficit. Interventions to anticipate needs and explain process. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #3 had a brief interview mental status (BIMS) score of 99 which indicated Resident #3 was unable to complete the interview. Resident #3 was dependent on staff for shower/bathing and personal hygiene. Review of the bathing schedule revealed Resident #3 was scheduled to be bathed on Wednesdays and Fridays on night shift. A shower sheet dated 06/12/24 revealed Resident #3 received a bed bath. Nail care was marked as not done. A shower sheet dated 06/14/24 revealed Resident #3 received a bed bath. Nail care was marked as not done. A shower sheet dated 06/19/24 revealed Resident #3 received a bed bath. Nail care was marked as not done. A weekly skin assessment dated [DATE] revealed Resident #3 had excessive dry flaky skin to bilateral feet. A shower sheet dated 06/21/24 revealed Resident #3 received a bed bath and refused nail care. A shower sheet dated 06/25/24 revealed Resident #3 received a bed bath. Nail care was not marked as being done. A shower sheet dated 06/28/24 was signed but did not reveal what care was provided. A weekly skin assessment dated [DATE] revealed Resident #3 did not have excessive dry skin. Body audit sheets (instead of shower sheets) dated 07/03/24 and 07/05/24 were provided but did not reveal what care was provided. A weekly skin assessment dated [DATE] revealed Resident #3 did not have excessive dry skin. Observation on 07/08/24 at 9:10 A.M. revealed Resident #3 was lying in bed. Resident #3 had long fingernails with a dark substance under the nails. Page 1 of 6 365933 365933 07/08/2024 Buckeye Terrace Rehabilitation and Nursing Center 140 N State Street Westerville, OH 43081

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 07/08/24 at 11:23 A.M. with the Director of Nursing (DON) verified Resident #3 had long fingernails with a dark substance under the nails. The DON removed Resident #3's socks. As Resident #3's socks were removed, large chunks of dry skin were observed falling onto the sheet. The top and bottom of both feet were covered in an excessive amount of dry flaking skin. Observation of Resident #3's left heel revealed a large area of hard, dry skin. The DON stated the wound nurse practitioner would be at the facility on 07/08/24 and would look at Resident #3's heels to see if the hard dry skin was a deep tissue injury. The DON verified there was an excessive amount of dry flaky skin to Resident #3's feet. Interview on 07/08/24 at 3:42 P.M. with Wound Nurse Practitioner #105 revealed they had observed Resident #3's feet and ordered ammonium lactate lotion (to treat dry or scaly skin). Wound Nurse Practitioner #105 stated Resident #3 did not have any wounds or pressure areas to bilateral feet, but Resident #3 did have a lot of dry flaking skin to bilateral feet. This deficiency represents non-compliance investigated under Complaint Number OH00154968. 365933 Page 2 of 6 365933 07/08/2024 Buckeye Terrace Rehabilitation and Nursing Center 140 N State Street Westerville, OH 43081

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 and staff interview, the facility failed to assess pressure ulcers and put treatments in place in a timely manner for Residents #1, #2, and #3. The facility also failed to identify a pressure ulcer Resident #3 developed until it was a Stage III (full-thickness loss of skin, in which adipose (fat) is visible in the ulcer. Slough and/or eschar may be visible) pressure ulcer. This affected three (Resident #1, #2, and #3) out of three residents reviewed for pressure ulcers. The facility census was 59. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #3 was admitted on [DATE] with diagnoses that included anoxic brain damage, chronic obstructive pulmonary disease, metabolic encephalopathy, history of transient ischemic attack, attention deficit hyperactivity disorder, and chronic kidney disease. Review of the nursing admission care plan dated 04/10/24 revealed Resident #3 had a Stage II (partial-thickness skin loss involving the epidermis and dermis) pressure ulcer to sacrum that measured two centimeters (cm) long, one cm wide, and 0.2 cm deep. Review of the Braden scale dated 04/10/24 for predicting pressure sore risk revealed Resident #3 was at high risk. Review of the treatment administration record (TAR) from 04/10/24 to 04/22/24 revealed Resident #3's sacrum was to be cleansed with normal saline, patted dry, covered with barrier cream and a foam dressing every day and as needed. Review of the plan of care dated 04/11/24 revealed Resident #3 had a skin impairment related to a sacrum wound. Interventions included to encourage Resident #3 to float heels as tolerated, encourage to turn and reposition every two hours and as needed, and weekly treatment documentation to include measurement of each skin breakdown's width, lengthy, depth, type of tissue and exudate, and any other notable changes. Review of the wound nurse practitioner (NP) initial consultation note dated 04/15/24 revealed Resident #3 had a Stage III pressure ulcer to left buttock measuring 2.8 cm long, 2.2 cm wide, and 0.2 cm deep. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #3 had a brief interview mental status (BIMS) score of 99 which indicated Resident #3 was unable to complete the interview. The MDS also revealed Resident #3 had a Stage III pressure ulcer upon admission. The wound NP note dated 04/22/24 revealed Resident #3 had a Stage III pressure ulcer to left buttock that measured 0.2 cm long, 0.2 cm wide, and 0.1 cm deep. The TAR revealed triad (a sterile coating that can be used on broken skin, keeping the wound covered and protected from incontinence) paste was applied to wound bed and covered with bordered gauze from 04/24/24 through 05/08/24. The wound NP note dated 04/29/24 revealed Resident #3 had a Stage III pressure ulcer to the left buttock that measured 0.3 cm long, by 0.8 cm wide, by 0.1 cm. in depth. Triad paste was to be applied to the wound and the area was to be left open to air. The treatment was not initiated until 10 days later on 05/09/24. The TAR revealed triad paste was applied to wound bed and left open to air from 365933 Page 3 of 6 365933 07/08/2024 Buckeye Terrace Rehabilitation and Nursing Center 140 N State Street Westerville, OH 43081

F 0686 05/09/24 through 06/21/24. Level of Harm - Minimal harm or potential for actual harm The wound NP note dated 05/13/24 revealed Resident #3 had a new Stage III pressure ulcer to coccyx that measured 1.2 cm long, 0.7 cm wide, and 0.2 cm deep. The coccyx wound was to have triad paste applied to the wound and left open to air every shift. There was no treatment in place to the coccyx from 05/13/24 until 06/06/24. Residents Affected - Few Review of the TAR for May 2024 revealed no evidence of treatment to coccyx. The TAR revealed a treatment to Resident #3's coccyx of triad paste to wound and wound left open to air was completed from 06/06/24 to 06/12/24. Wound NP note dated 05/20/24 and 05/28/24 revealed Resident #3 had a Stage III pressure ulcer to left buttock and a Stage III pressure ulcer to the coccyx. The Wound NP note dated 06/10/24 revealed Resident #3 had a Stage III pressure ulcer to left buttock. The Stage III pressure to the coccyx was healed. Wound NP note dated 06/17/24 revealed the Stage III pressure ulcer to Resident #3's left buttock was healed. Interview on 07/08/24 at 2:59 P.M. with the Director of Nursing (DON) verified the wound NP note dated 04/29/24 revealed the Stage III pressure ulcer to Resident #3's left buttock was to have triad pasta applied and left open to air and the new treatment was not put in place until 05/09/24. The DON also verified the TAR for May 2024 revealed there was no documentation of treatment to the Stage III pressure ulcer to coccyx identified on 05/13/24. The DON verified the pressure ulcer to Resident #3's coccyx was not identified until it was a Stage III. 2. Review of the medical record revealed Resident #1 was admitted on [DATE] with diagnoses that included acute respiratory failure, cardiac arrest, acute kidney failure, and schizoaffective disorder. The hospital documentation revealed Resident #1 had a unstageable pressure ulcer (Slough and/or eschar: known but not stageable due to coverage of wound bed by slough and/or eschar) to the coccyx. Review of the admission care plan dated 05/14/24 revealed Resident #1 had an open area to bottom. No measurements or description of the open area was documented. A weekly skin assessment dated [DATE] revealed Resident #1 had a pressure ulcer to coccyx. No measurements or description of the pressure ulcer was documented. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was cognitively intact. The MDS revealed Resident #1 did not have any skin impairment. A weekly skin assessment dated [DATE] revealed Resident #1 had a pressure ulcer to coccyx. No measurements or description of the pressure ulcer was documented. A wound NP note dated 05/28/24 revealed Resident #1 had an unstageable pressure ulcer to coccyx that measured 3.4 cm long and 1.1 cm wide. After debridement, the pressure ulcer was 0.2 cm deep. An order was put in place to cleanse the pressure wound with normal saline, pat the wound dry, apply silver alginate and cover with bordered gauze dressing every day. Review of the treatment administration record (TAR) for May 2024 revealed no treatments for the open area to Resident #1's coccyx. A wound NP note dated 06/03/24 revealed Resident #1 had an unstageable pressure to coccyx that 365933 Page 4 of 6 365933 07/08/2024 Buckeye Terrace Rehabilitation and Nursing Center 140 N State Street Westerville, OH 43081

F 0686 Level of Harm - Minimal harm or potential for actual harm measured 3.4 cm long and 1.4 cm wide. A new order was put in place for pressure ulcer to be cleansed with normal saline, Medi honey and calcium alginate applied, and covered with bordered gauze. Review of the TAR revealed the treatment ordered on 06/03/24 was not started until three days later on 06/06/24. Residents Affected - Few A wound NP note dated 06/10/24 revealed Resident #1 had a Stage III pressure ulcer to coccyx that measured 3.1 cm long, and 1.1 cm wide, and 0.4 cm deep. A wound NP note dated 06/17/24 revealed Resident #1 had a Stage III pressure ulcer to coccyx that measured 2.1 cm long, 0.8 cm wide, and 0.4 cm deep. A wound NP note dated 07/01/24 revealed Resident #1 had a Stage III pressure ulcer to coccyx that measured 1.4 cm long, 0.4 cm wide, and 0.1 cm deep. Interview on 07/08/24 at 4:34 P.M. with the Director of Nursing (DON) verified there was no description or measurements of the pressure ulcer to Resident #1's coccyx from 05/14/24 until 05/28/24. The DON also verified no treatments for the pressure ulcer to Resident #1's coccyx was not put in place until 06/06/24. 3. Review of the medical record revealed Resident #2 was admitted on [DATE] with diagnoses that included alcoholic hepatitis, asthma, cirrhosis of the liver, and severe protein-calorie malnutrition. Review of the admission care plan dated 05/04/24 revealed Resident #2 had a pressure ulcer to coccyx. No measurements or description of the pressure ulcer was documented. The weekly skin assessment dated [DATE] revealed Resident #2 had a pressure ulcer to coccyx. No measurements or description of the pressure ulcer was documented. The care plan also revealed Resident #2 had the potential of impairment to skin. Interventions included to encourage Resident #2 to float heels. Review of the TAR revealed the treatment to cleanse Resident #2's pressure ulcer with normal saline, apply triad paste, and leave open to air was started on 05/09/24, three days after identifying the wound to the coccyx. Review of the Medicare five-day MDS assessment dated [DATE] revealed Resident #2 was cognitively intact. Resident #2 had a Stage III pressure ulcer on admission. The wound NP note dated 05/13/24 revealed Resident #2 had a Stage III pressure ulcer to coccyx that measured 1.2 cm long, 0.6 cm wide, and 0.2 cm deep. The Wound NP note dated 05/20/24 revealed Resident #2 had a Stage III pressure ulcer that measured 1.1 cm long, 0.6 cm wide, and 0.2 cm deep. Wound NP note dated 05/28/24 revealed Resident #2 had a Stage III pressure ulcer to coccyx that measured 0.9 cm long, 0.7 cm wide, and 0.2 cm deep. Wound NP note dated 06/03/24 revealed Resident #2 had a Stage III pressure ulcer to coccyx that measured 0.7 cm long, 0.9 cm wide, and undetermined depth. Wound NP note dated 06/10/24 revealed Resident #2 had a Stage III pressure ulcer to coccyx that measured 0.4 cm long, 0.6 cm wide, and undetermined depth. Wound NP note dated 06/17/24 revealed the Stage III pressure ulcer to Resident #2's coccyx was healed. Interview on 07/08/24 at 5:04 P.M. with the DON verified Resident #2 was admitted on [DATE] and a treatment to coccyx was not put in place until 05/09/24. The DON also verified no measurements or description of the wound was documented until 05/13/24 when the pressure ulcer was identified as a Stage III. 365933 Page 5 of 6 365933 07/08/2024 Buckeye Terrace Rehabilitation and Nursing Center 140 N State Street Westerville, OH 43081

F 0686 This deficiency represents non-compliance investigated under Complaint Number OH00154968. Level of Harm - Minimal harm or potential for actual harm This deficiency is an example of continued non-compliance from the complaint survey dated 06/13/24. Residents Affected - Few 365933 Page 6 of 6