Inspection·December 4, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation and interview, the facility failed to maintain Resident #34's heel protector boots to prevent the development of pressure ulcers and failed to obtain laboratory tests and a wound clinic referral to manage Resident #52's wounds in a timely manner. This affected two residents (#34 and #52) out of three residents reviewed for wound care. The facility census was 57.Findings include:1. A review of Resident #52's clinical record revealed an admission date of 10/23/25 and re-admission date of 11/18/25 with diagnoses including gastrointestinal hemorrhage, nontraumatic subarachnoid hemorrhage, trouble swallowing, diabetes mellitus, high blood pressure, anemia, heart failure, neuromuscular dysfunction of the bladder, sacral pressure ulcer, malnutrition, alcohol abuse, anxiety, depression, gastroesophageal reflux disease, peripheral vascular disease, hydrocephalus disease, aneurysm, cerebrovascular vasospasm, Cushing's disease (rare endocrine disorder where a benign pituitary tumor secretes too much, causing too much adrenocorticotropic hormone, causing the adrenal glands to overproduce the stress hormone cortisol), constipation, obstructive and reflux uropathy.A review of Certified Nurse Practitioner (CNP) #91's progress note dated 11/04/25 indicated she wrote an order to obtain a referral to the wound clinic and to recheck laboratory test for a comprehensive metabolic panel (CMP). On 11/09/25 CNP #91's progress note indicated a referral was made on 11/04/25, and the facility had failed to call the wound clinic for the referral and had not obtained the laboratory test for the CMP as ordered on 11/04/25.Resident #52's wound documentation dated 12/01/25 indicated the presence of an unstageable pressure ulcer (a deep wound where the true depth and extent of tissue damage can't be determined because the base is covered by yellow (slough) or black/brown (eschar) dead tissue) on the sacrum measuring 12.1 centimeters (cm) long by 10.9 cm wide and 1.3 cm deep.An interview with CNP #91 on 12/03/25 at 9:51 A.M. verified the facility had not obtained the wound clinic referral and laboratory tests CNP #91 had ordered on 11/04/25.An interview on 12/03/25 at 3:35 P.M. with Regional Director of Clinical Operations (RDCO) #92 verified the above findings and agreed the staff had failed to draw the CMP laboratory test or submit a referral for the wound clinic to manage Resident #52's wounds.2. Review of the medical record for Resident #34 revealed an admission date of 06/27/23 and a readmission date of 09/05/23. Diagnoses included diabetes mellitus, chronic kidney disease, and polyneuropathy.A review of Resident #34's care plan initiated on 06/30/25 indicated Resident #34 had potential for skin breakdown and required protective/preventative skin care maintenance to both heels. Interventions on the care plan included maintaining heel protector boots while in bed.Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 09/22/25, revealed Resident #34 had moderately impaired cognition and was dependent on staff for activities of daily living (ADL).Review of the physician's orders for December 2025 revealed that Resident #34 was ordered bilateral heel protector boots while in bed as tolerated two times a day.Observation on 12/03/25 at 8:56 A.M. revealed that Resident #34 was lying in bed, her heel protector boots were lying against the wall. Resident #34 stated that her boots should have been on. This was verified by Licensed Residents Affected - Few (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 4 Event ID: 366123 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 366123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accord Care Community Orrville LLC 1980 Lynn Drive Orrville, OH 44667 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)