Health inspection·October 17, 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 medical record review, staff interview, and facility policy, the facility failed to ensure treatments were implemented timely for pressure ulcers. This affected one (#46) of three residents reviewed for pressure ulcers. The facility census was 49. Residents Affected - Few Findings include: Review of the medical record revealed Resident #46 was admitted to the facility on [DATE]. Diagnoses included cerebral infarction due to thrombosis of left middle cerebral artery, hemiplegia right dominant side, spinal stenosis, major depressive disorder recurrent, pressure ulcer of the right heel, gastrostomy status, acute cystitis without hematuria, hyperlipidemia, and atherosclerotic heart disease of native coronary artery without angina pectoris. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was moderately cognitively impaired, dependent for all care, and had a stage three pressure ulcer. Review of the admission nursing assessment dated [DATE] revealed Resident #46 readmitted to the facility after a hospital discharge. Review of the skin integrity documented a new unstageable right heel pressure ulcer that measured 3.1 centimeters (cm) in length by 2 cm in width. Review of nursing progress note dated 07/21/24 revealed Resident #46 had an area to the outer right heel 3.0 cm oval shaped black hard area noted with the area around the area blanchable. Blue boots bilateral were on. Review of nursing progress notes dated 07/23/24 revealed Resident #46's outer right heel was assessed. The area was discolored, soft measures 4 cm by 3 cm. Offloading boots and air mattress present on admission when wound noted. The nurse practitioner was aware, skin prep daily, and continue offloading boots. Review of the wound nurse practitioner consultation dated 07/30/24 revealed a new suspected deep tissue injury on the right lateral heel. Measurements were documented as 3 cm in length by 4 cm in width with new treatment orders. Review of the medical record revealed no previous orders provided treatment to the right heel. Interview on 10/17/24 at 8:24 A.M. with Unit Manager Licensed Practical Nurse (LPN) #204 verified Resident #46 had a suspected deep tissue injury upon readmission from the hospital on [DATE] and no treatment orders were in place until 07/30/24. (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: 366255 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 366255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vancrest Health Care Ctr of Ho 600 Joe E Brown Road Holgate, OH 43527 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)