Health inspection·January 19, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident and staff interview, review of the facility policy, and review of the guidelines from the National Pressure Ulcer Advisory Panel (NPUAP), the facility failed to implement a comprehensive and individualized pressure ulcer prevention program for Resident #25 to prevent the development of an unstageable (full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because the wound bed is obscured by slough or eschar) pressure ulcer. The facility also failed to accurately assess the wound as a facility acquired pressure ulcer. Residents Affected - Few Actual Harm occurred on 11/27/23 when Resident #25, who was at risk for pressure ulcers and required staff assistance for bed mobility and incontinence care was found to have an unstageable pressure ulcer to the sacrum without evidence of adequate interventions to prevent the development or timely identify the pressure ulcer prior to it being unstageable. This affected one resident (#25) of three residents reviewed for pressure ulcers. The facility census was 75. Findings include: Review of the medical record revealed Resident #25 was admitted on [DATE] with diagnoses including a fracture to the left femur, type II diabetes mellitus, spinal stenosis, and intellectual disabilities. Review of the hospital paperwork dated 11/22/23 revealed Resident #25 did not have skin breakdown upon discharge from the hospital. Review of the plan of care dated 11/22/23 revealed Resident #25 was at risk for impaired skin integrity related to the resident being confined to bed or chair most of the time, diabetes, impaired cognition, incontinence of bowel and bladder, pain, and required staff to assist with repositioning. Interventions included assisting Resident #25 with turning and repositioning as needed and completing a skin inspection every seven to ten days and as needed. On 11/29/23, a new intervention of an air mattress was added to the plan of care. Review of the admission note dated 11/22/23 at 4:45 P.M. revealed Resident #25 required two-persons assist for transfers and one-person assist for bed mobility. No skin impairments were observed. The Braden Scale used to determine the risk level for the development of pressure ulcers revealed Resident #25 was able to respond meaningfully to pressure-related discomfort, was rarely moist, was chairfast, had very limited ability to change and control body position, had adequate food intake, had no apparent problem with friction or shearing as evidenced by Resident #25 being able to move in bed/chair independently and had sufficient muscle strength to lift up completely during movement and maintained good position in bed/chair at all times. A Braden Scale assessment, revealed Resident #25 was (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: 366095 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 366095 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glenwood Care and Rehabilitation 836 West 34th Street NW Canton, OH 44709 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)