Health inspection·November 17, 2025

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few surgical area and a newly acquired pressure and surgical area. There was no documented evidence of descriptions of the wounds. Review of Resident #7's skin grid non-pressure assessment dated [DATE] revealed the resident had MASD on the sacrum that was present on admission [DATE]) that measured 1.1 cm by 1.3 cm by 0.1 cm. There was moderate drainage, the type of drainage was not identified. No odor or tunneling/undermining. There was no description of the wound or evidence the physician was notified. Review of Resident #7's actual skin impairment integrity/pressure ulcer related to MASD, left heel/sacrum plan of care dated 09/17/25 revealed interventions including complete skin documentation per facility policy, provide wound care per physician order, and refer to wound physician as needed. Review of Resident #7's weekly skin observation dated 09/17/25 revealed the resident's skin was not intact. The resident had MASD and pressure previously identified. There were no descriptions of the wounds. Review of Resident #7's skin grid non-pressure dated 09/19/25 revealed the resident had MASD on the sacrum that was acquired on 08/21/25 that measured 1.0 cm by 1.2 cm by 0.1 cm and 100% granulation. There was scant drainage, type not of drainage not identified. No odor or tunneling. There was no evidence that the physician was notified. Review of Resident #7's weekly skin observation dated 09/24/25 revealed the resident's skin was not intact. The resident had MASD and pressure previously identified. There were no descriptions of the wounds. Review of Resident #7's weekly skin grid pressure ulcer assessment for 08/28/25, 09/04/25, 09/11/25, 09/18/25, and 09/25/25 revealed no evidence a skin pressure ulcer assessment was completed on the sacrum. Review of Resident #7's weekly skin grid pressure dated 09/26/25 revealed the resident had a stage II pressure ulcer (partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough, may also present as an intact or open/ruptured serum filled blister) on the sacral region that originated on 08/21/25 that measured 2.5 cm by 4.5 cm by 0.2 and was a stage III pressure ulcer (full thickness tissue loss, subcutaneous fat may be visible but bone, tendon or muscle are not exposed, slough may be present but does not obscure the depth of tissue loss, may include undermining and tunneling) per the wound nurse consult dated 09/26/25. The area was 90% granulation, 10% slough, and peri wound moist and fragile. There was moderate serosanguinous drainage with no odor. The wound status since last assessment was left blank and no evidence that the physician was notified. Review of Resident #7's medication and treatment record and orders dated 08/21/25 to 09/30/25 revealed no evidence a treatment was implemented to the sacrum area from 08/21/25 to 09/03/25. Review of Resident #7's wound nurse consult note dated 09/26/25 revealed the wound nurse completed a telehealth visit due to unavailability or difficulty with coordinating in person evaluation. The initial assessment revealed the wound on the sacral area was a stage III due to there being 10% slough covering the wound bed. The area was not measured. There was moderate serosanguinous drainage, and the skin was moist and fragile. The treatment plan would change to silver alginate covered with silicone dressing daily and as needed. Recommend a pressure reduction cushion in wheelchair. Review of Resident #7's physician progress notes dated 08/21/25 to 09/30/25 revealed no evidence the physician had mentioned or assessed the pressure ulcer on the sacrum. Observation of Resident #7 on 09/29/25 at 1:48 A.M., with Licensed Practical Nurse (LPN) #108 revealed the resident was up in her wheelchair in therapy. Therapy stood the resident up, and there was no pressure relieving cushion in the resident's wheelchair. The resident had a [NAME] Virginia (WV) stadium cushion that was flat. The LPN and therapy staff confirmed the WV stadium cushion was flat and not a proper pressure relieving cushion. Interview on 09/29/25 at 12:52 P.M., with LPN #108 and Interim Director of Nursing (DON) #140 and New DON #200, who started today, confirmed Resident #7 was re-admitted on [DATE] with a pressure ulcer on the sacrum. The LPN reported he recently just took over wounds and was not certified in wound care. The LPN confirmed on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366331 If continuation sheet Page 2 of 3 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 366331 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sienna Skilled Nursing & Rehabilitation 250 Cadiz Road Wintersville, OH 43953 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 08/28/25 09/04/25, 09/11/25, 09/18/25 or 09/25/25 he did not complete the weekly pressure ulcer assessment form; however, he was still learning and documented the area on the non-pressure form as MASD instead of pressure. Interim DON #140 confirmed there was no documented evidence the resident's physician had accessed the pressure ulcer, and the wound nurse did not assess the pressure ulcer until 09/26/25 due to the resident was in dialysis on the day the wound nurse visits the facility. LPN #108 and DON confirmed there was no evidence a treatment was implemented to the sacrum from 08/21/25 until 09/03/25. DON #140 reported she felt the non-pressure assessments were comprehensive even though the assessment did not document the stage of the pressure nor was it comprehensive to include all details regarding the description of the wound (wound bed appearance, edge of wound, type of drainage, etc.). Interview on 09/29/25 at 3:35 P.M., LPN #120 confirmed the admission and five-day MDS dated [DATE] was inaccurate and did not reflect the resident's pressure ulcer on the sacrum on admission [DATE]. LPN #120 reported she would modify the MDS assessment. Review of the facility's undated policy and procedure titled Skin Measurement/Skin Grid revealed the facility would maintain an active record or any pressure ulcer/wound that was discovered upon admission or that developed during the course of the residents' stay. This is to monitor the progress of healing of the pressure ulcer and determine the need for alternative treatment methods. The wound would be measured and assessed for the wound characteristics. The physician and responsible party would be notified of the new skin development and an order for treatment would be obtained. The initial and every seven days assessment/measurements are documented on the electronic form. Review of the facility's undated policy and procedure titled Staging of Pressure Ulcers revealed the facility would assess each resident's skin condition and measure the skin area as indicated in the regulatory guidelines and National Pressure Injury Advisory Panel (NPIAP) guidelines. Review of the facility's undated policy and procedure titled Pressure Ulcer Prevention and Risk Identification revealed if a new skin area was identified on the assessment or during any other type of care or service, the licensed nurse would initiate a skin grid/measurement flow record. The skin grid would be updated every seven days until the area was resolved. The physician and responsible party would be notified by the licensed nurse promptly of the newly identified skin area and treatment would be initiated according to the physician order. A care plan would be developed and updated routinely with identified skin risk and/or actual wound development. Intervention would be implemented as indicated by the physician and as determined by the Interdisciplinary team. Review of the NPIAP wound documentation guidelines dated 02/2027 revealed when charting a description of a pressure ulcer the following components should be part of your weekly assessment: location, stage, dimensions, undermining/tunneling, wound base descriptions, drainage, wound edges, odor, pain, and progress. This deficiency represents non-compliance investigated under Complaint Number 2608722. Event ID: Facility ID: 366331 If continuation sheet Page 3 of 3