Health inspection·May 29, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review, the facility failed to ensure a treatment was implemented when Resident #8 obtained a skin tear and the treatment was discontinued when the skin tear was resolved. This affected one resident (#8) of two residents reviewed for skin conditions. The facility census was 19. Residents Affected - Few Findings include: Review of the medical record for Resident #8 revealed an admission date of 10/16/23. Diagnoses included but were not limited to hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right dominant side, personal history of transient ischemic attack, anxiety disorder, muscle weakness and depression. Review of the progress notes dated 04/26/25 at 1:06 P.M. revealed resident obtained a two (2) centimeter(cm) by (x) 2 cm skin tear to the back of the right hand. Review of the physician orders for Resident #8 from 04/26/25 through 04/29/25 at 11:08 A.M. revealed no treatment was ordered for the skin tear to the back of the resident's right hand. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of 04 which indicated severe cognitive impairment. The resident was assessed to require substantial/maximum assistance with toilet hygiene, shower/bathe self, bed mobility and transfers. Review of the weekly skin observation tool dated 04/29/25 for Resident #8 revealed a skin tear to the back of the right hand that measured 2.0 cm x 2.0 cm x 0.1 cm. Review of the plan of care revised 04/29/25 revealed the resident had a skin tear to the right hand with an intervention including but not limited to treat per facility protocol. Review of the physician order dated 04/29/25 at 11:08 A.M. for Resident #8 revealed a treatment for the right-hand skin tear, to cleanse skin tear with soap and water, pay dry and apply a clean, dry dressing every evening shift. Review of the weekly skin observation tool dated 05/06/25 for Resident #8 revealed the skin tear to the back of the right hand to be measured at 1.0 cm x 1.0 cm x 0.1 cm. Further review of the weekly skin observation tools dated 05/13/25, 05/20/25 and 05/27/25 for this resident revealed no skin tear to the back of the right hand was observed and no wound measurements Page 1 of 4 366314 366314 05/29/2025 Otterbein at Granville 2158 Columbus Road Granville, OH 43023

F 0684 were noted. Level of Harm - Minimal harm or potential for actual harm Review of the Treatment Administration Record (TAR) for 05/13/25 through 05/27/25 revealed Resident #8 received ordered treatments for the right back of the hand skin tear even after the weekly skin assessments were completed with no skin tear present. Residents Affected - Few Observation on 05/28/25 at 2:34 P.M. of Resident #8's back of the right hand revealed no skin tear and no dressing. Interview on 05/28/25 at 3:05 P.M. with the Director of Nursing and the Assistant Director of Nursing verified there was no order for the skin tear to the back of the hand from 04/26/25 until 04/29/25 at 11:08 A.M. for Resident #8. Also verified this resident still had an active order for the treatment of the back of the right-hand skin tear as of 05/28/25 with documentation of the nursing staff providing the ordered treatment on the TAR for the dates of 05/06/25 through 05/28/25. The area was healed after the 05/06/25 weekly skin observation tool, but the ADON was not sure when as it was not documented. 366314 Page 2 of 4 366314 05/29/2025 Otterbein at Granville 2158 Columbus Road Granville, OH 43023

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 interview, record review and facility policy review, the facility failed to ensure comprehensive pressure wound assessments were completed weekly. This affected one resident (#17) of two residents reviewed for pressure ulcers. The census was 19. Residents Affected - Few Findings include: Review of the medical record for Resident # 17 revealed an admission date of 03/15/25. Diagnoses included but were not limited to pressure ulcer to the sacral region stage II (partial-thickness skin loss, presenting as an open sore or blister with a red or pink wound bed), depression, anxiety disorder, moderate protein-calorie malnutrition, hemiplegia and hemiparesis following cerebral infarction affecting right dominant side and acute chronic systolic heart failure. Review of the plan of care dated 03/15/25 for Resident #17 revealed her to have a stage II pressure ulcer area to the coccyx on admission and interventions including but not limited to assess/monitor the wound for healing. Assess and document the status of the wound perimeter, wound bed and healing process. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of 13 which indicated the resident was cognitively intact. The resident was assessed to require supervision or touching assistance for showers/bathing self, partial/moderate assistance for toilet hygiene, roll left to right in bed transfers, substantial/maximum assistance with sit to lying and lying to sitting. This resident was also assessed to be at risk for developing pressure ulcers and to have a pressure ulcer on admission of a stage II. Review of the weekly skin observation tools dated 03/18/25, 03/25/25, 04/01/25 and 04/08/25 revealed no wound staging to the pressure ulcer on the resident's coccyx. Further review of the weekly skin observation tools for the pressure ulcer to the resident's coccyx, dated 03/25/25, 04/01/25, 04/22/25, 04/29/25, 05/06/25 and 05/20/25 revealed no assessment of the wound bed, wound edges or surrounding tissue was documented. Interview on 05/28/25 at 3:20 P.M. with the Assistant Director of Nursing verified no staging was documented for Resident #17's coccyx pressure ulcer on the weekly skin observation tools for the dates of 03/18/25, 03/25/25, 04/01/25, and 04/08/25. Interview on 05/29/25 at 9:27 A.M. with the Certified Nurse Practitioner #102 revealed it was the responsibility of the facility nurses to measure and document on the descriptions of pressure ulcers weekly as she does not always assess pressure ulcers at each visit and goes reviews their measurements for treatments. Interview on 05/29/25 at 9:40 A.M. with Regional Nurse (RN) #102 verified for the weekly skin observation tools dated for 03/25/25, 04/01/25, 04/22/25, 04/29/25, 05/06/25 and 05/20/25 did not include an assessment of the wound bed, wound edges or surrounding tissue. The RN verified this is part of the assessment and should have been included for Resident #17's coccyx pressure ulcer. Review of the facility policy titled Skin Care Management Procedure revised 12/09/22, revealed at 366314 Page 3 of 4 366314 05/29/2025 Otterbein at Granville 2158 Columbus Road Granville, OH 43023

F 0686 Level of Harm - Minimal harm or potential for actual harm least weekly at a minimum, documentation should include staging, wound bed which includes color and type of tissue/character including evidence of healing or necrosis and percent of tissue, and description of wound edges and surrounding tissue. Residents Affected - Few 366314 Page 4 of 4