Health inspection·June 7, 2024

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 observation, interview and record review the facility failed to assess the skin underneath Resident #28's right lower extremity hinged brace resulting in an in-house acquired stage II pressure ulcer under the brace. This affected one resident (#28) of three residents reviewed for pressure ulcers. The facility census was 52. Residents Affected - Few Findings include: Review of the medical record for Resident #28 revealed an admission date of 04/23/24. Diagnoses included displaced comminuted fracture of the shaft of the right femur, chronic atrial fibrillation, and cerebral infarction. Review of the physician's order dated 04/26/24 revealed Resident #28 had an order for a right lower extremity hinged brace which was to remain intact and only to be removed for personal hygiene. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #28 had moderate cognitive impairment. Resident #28 required substantial/maximal assistance for eating, oral hygiene, upper body dressing, and showering/bathing. Resident #28 was dependent for toileting, lower body dressing, and putting on and taking off footwear. Resident #28 was frequently incontinent of urine and bowel. Resident #28 had no pressure ulcers on admission and was at risk of developing pressure ulcers. Review of the care plan for Resident #28 dated 05/08/24 revealed she was at risk for skin breakdown. Interventions included to assess skin weekly and turn and reposition every two hours. Review of the nursing progress note dated 05/18/24 for Resident #28 revealed an area was found on her right outer lower extremity under the hinged brace. The physician and her family were notified. Review of the skin incident/accident witness statement dated 05/18/24 authored by Licensed Practical Nurse (LPN) #530 revealed she was called to Resident #28's room by a state tested nurse aide (STNA) and observed the area to the right outer lower leg. Review of the skin incident/accident witness statement dated 05/18/24 by STNA #522 revealed she was doing care for Resident #28 when she complained of pain in her right lower leg. The STNA #522 got a mirror and looked inside her brace and found a new skin area and notified the nurse. There was no documented evidence that treatment orders were implemented until 05/20/24. Review of weekly skin assessment dated [DATE] revealed family was notified of the wound on (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 2 Event ID: 366191 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 366191 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maplecrest Nursing and Hta 400 Sexton Street Struthers, OH 44471 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)