Inspection·October 27, 2025

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 facility policy review, the facility failed to ensure a physician order for a pressure ulcer treatment was transcribed into the electronic medical records. This affected one resident (#136) of three residents reviewed for physician orders. The facility census was 151.Findings include:Review of Resident #136 ' s medical record revealed an admission date of 02/04/25. Diagnoses included a stage four pressure ulcer (a full thickness wound involving muscle, tendon, and/or bone involvement) to the sacrum (tailbone area), stroke with right sided weakness, and malnutrition.Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #136 had intact cognition. Resident #136 was dependent on staff for toileting, bathing, and personal hygiene. Review of the care plan dated 09/18/25 revealed Resident #136 had an actual skin impairment. Interventions included a negative pressure wound vac set at 125 millimeters of mercury (mmHg) of pressure and change the wound vac dressing three times a week on every Tuesday, Thursday, and Saturday, and as needed. Review of Resident #136 ' s physician orders for October 2025 revealed to change wound vac dressing three times a week on Tuesdays, Thursdays and Saturdays and as needed. Physician orders had not included specific information regarding the type of dressing or treatments.Review of a progress note dated 10/17/25 authored by Wound Nurse Practitioner (WNP) #355 revealed orders that included cleanse the sacral area with Dakins (antiseptic) solution, apply skin prep and stoma paste, apply a transparent drape to the area, cut black foam to fit the wound area and apply a transparent dressing over the black foam and set the wound vac to negative 125 mmHg continuously every Tuesday, Thursday, and Saturday.Interview on 10/21/25 at 3:00 P.M. with Registered Nurse (RN) #230, who was the facility's wound nurse, confirmed WNP #355 ' s orders had not been transcribed into his medical records and stated specific wound care orders should have been included in Resident #136 ' s physician orders. Review of the facility policy titled Physician Orders undated revealed physician orders will be transcribed into the electronic medical records.This deficiency represents non-compliance investigated under Complaint Number 2645034. Residents Affected - Few 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 2 Event ID: 366008 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 366008 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grande Pointe Healthcare Commu Three Merit Dr Richmond Heights, OH 44143 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)