Health inspection·May 16, 2023

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 observation, medical record review, staff interview, and review of a facility policy, the facility failed to ensure interventions to prevent skin breakdown were in place as ordered by the physician and per the resident plan of care. This affected two (#18 and #60) of three residents reviewed for pressure ulcers. The facility census was 86. Residents Affected - Few Finding include: 1. Review of the medical record for Resident #18 revealed an admission date of 03/06/23 with diagnoses including Alzheimer's disease, chronic obstructive pulmonary disease (COPD), osteoporosis, and mitral valve insufficiency. Review of the Minimum Data Set (MDS) assessment for Resident #18 dated 03/13/23 revealed the resident was cognitively impaired and required extensive assistance of one staff with activities of daily living (ADLs). Further review of the MDS assessment for Resident #18 revealed the resident was assessed with a stage four pressure ulcer (full-thickness skin and tissue loss) which was present upon admission to the facility. Review of the pressure ulcer risk assessment for Resident #18 dated 03/06/23 revealed the resident was at risk for the development of pressure ulcers. Review of the care plan for Resident #18 dated 03/06/23 revealed the resident had an alteration in skin integrity as evidenced by a pressure ulcer was present at the sacrum. Interventions included to elevate heels in bed as tolerated and as needed, encourage and assist the resident to turn and reposition as needed, provide assistance with ADLs and positioning as needed, provide the resident and family education on skin impairment and potential complications as needed, provide skin care as needed, and provide treatments per physician orders. Review of the care plan for Resident #18 dated 03/14/23 revealed the resident was at risk for alteration in skin integrity related to blood disease, cognitive impairment, dementia, incontinence, mobility impairment, and existing pressure ulcer. Interventions included that staff should encourage and assist the resident to elevate heels when in bed as needed and as tolerated, and provide assistance with ADLs and positioning as needed. Review of Resident #18's May 2023 monthly physician orders revealed an order dated 03/06/23 to encourage and assist the resident to float heels every shift. Review of the May 2023 treatment administration record (TAR) for Resident #18 revealed the order to float heels was signed off as completed daily every shift. (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: 366251 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 366251 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Home at Hearthstone, The 8028 Hamilton Avenue Cincinnati, OH 45231 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)