Inspection·February 20, 2024

F 0677 scheduled for 9:00 A.M., 1:00 P.M. and 6:00 P.M. daily. Level of Harm - Minimal harm or potential for actual harm Observation on 02/12/24 at 12:11 P.M. revealed State Tested Nurse Aide (STNA) #4 walking into Resident #92's room carrying Resident #92's lunch meal tray. Resident #92 was lying in bed with her upper body leaning to the left side of the bed, almost against the left handrail. STNA #4 placed the meal tray on the overbed table that was over the resident's bed. STNA #4 poured creamer in the coffee cup, removed the lid from the Magic Cup and removed the lid from the plate of food which included roast beef and potatoes and carrots with a slice of chocolate cream pie. STNA #4 assisted Resident #92 with sitting up straight in bed by pulling on her right arm. STNA #4 exited the room without assisting Resident #92 with eating or cuing the resident. STNA #4 continued passing meal trays to other residents eating in their rooms. At 12:15 P.M., Resident #92 was observed holding a full cup of coffee with her right hand, the cup was tilted towards her mouth and coffee was spilling on the bed linens. An attempt to interview Resident #92 during the observation was unsuccessful due to cognitive impairment. At 12:18 P.M., Resident #92 was observed lying in bed, awake with her head rested against her pillow and her right hand on the coffee cup which was sitting on the meal tray. At 12:20 P.M., 12:22 P.M., 12:25 P.M. and 12:30 P.M., Resident #92 was observed asleep in bed with her right hand on the coffee cup; the food was untouched. At 12:33 P.M., Resident #92 continued to sleep but her hand was no longer on the coffee cup. At 12:35 P.M., 12:38 P.M., and 12:40 P.M. Resident #92 was observed sleeping. At 12:44 P.M., STNA #4 walked past Resident #92's room, peered into the room and kept walking down the hall. At 12:48 P.M., Resident #92 continued to sleep with her upper body leaned to the left side of the bed, almost against the left handrail. At 12:57 P.M., Resident #92 was awake, calling out, is anyone else there? From 12:11 P.M. to 1:05 P.M. no staff entered Resident #92's room to cue or assist Resident #92 with her meal. At 1:05 P.M., STNA #4 entered Resident #92's room and asked the resident, what about eating your lunch? Do you want me to leave it here? I'll leave it here for a while. Resident #92's meal tray contained untouched pot roast, potatoes, carrots, chocolate cream pie and a Magic Cup. Interview, during the observation, with STNA #4 revealed Resident #92 did not eat a lot and was able to feed herself. STNA #4 verified Resident #92 had not touched any of her food. Residents Affected - Few Interview on 02/12/24 at 1:18 P.M. with Resident #92's family member revealed Resident #92 could usually feed herself however the resident had been very sleepy since getting Morphine for pain. Interview on 02/12/24 at 2:55 P.M. with the Director of Nursing (DON), with the Administrator and Wound Nurse #1 present, revealed it was the expectation that Resident #92 be assisted with her meal if the plan of care indicated she was a one-person assistance with eating. Review of the facility's Assistance with Meals policy revised 01/24/24 revealed nursing staff and/or feeding assistants would feed those residents needing full assistance. Residents who could not feed themselves would be fed with attention to safety, comfort and dignity. This deficiency represents non-compliance investigated under Complaint Number OH00150259. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 2 of 8 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 366335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125 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 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 closed medical record review, policy review and interview, the facility failed to consistently implement physician wound care orders for a skin tear and vascular wounds for Resident #98. This affected one (Resident #98) of three residents reviewed for non-pressure wounds. The census was 97. Residents Affected - Few Findings include: Review of the closed medical record of former Resident #98 revealed an admission date of 12/10/23, discharge date of 02/10/24 with diagnoses of chronic systolic heart failure, diabetes, chronic kidney disease stage three, and chronic atrial fibrillation. Review of the Minimum Data Set (MDS) 3.0 admission assessment dated [DATE] revealed Resident #98 was cognitively intact, required partial/moderate assistance with toileting and rolling left and right in bed and had a skin tear. Review of the nursing progress note dated 12/14/23 revealed Wound Nurse (WN) #1 was in to assess Resident #98's right lower extremity (RLE). Upon assessment WN #1 noted skin tear to RLE. Resident #98 stated the skin tear occurred during transfer the previous night with a State Tested Nurse Aide (STNA). The area was cleansed, measured and a treatment was put in place. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a RLE skin tear measuring 3.0 centimeters (cm) by 3.5 cm with moderate bleeding. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a RLE skin tear measuring 2.9 cm by 3.4 cm with moderate bleeding. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a RLE skin tear measuring 3.0 cm by 3.5 cm by 0.1 cm with moderate clear drainage and increased edema. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a RLE skin tear measuring 3.1 cm by 2.8 cm by 0.1 cm with light bleeding drainage. Review of the nursing progress note dated 01/03/24 revealed Resident #98 was sent to the hospital for a change in condition related to breathing. Review of the nurse progress note dated 01/09/24 revealed Resident #98 was readmitted to the facility. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a RLE skin tear measuring 2.4 cm by 2.5 cm with light bleeding drainage and 10% eschar (dead hard tissue/scab) to wound and scabs to left lower extremity (LLE). Review of the physician order dated 01/10/24 revealed to clean RLE with normal saline, pat dry, apply Xeroform (petroleum based gauze), foam dressing and Ace wrap daily. Review of the January 2024 Treatment Administration Record (TAR) revealed there was no evidence Resident #98's RLE dressing was changed on 01/12/24, 01/13/24 and 01/14/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 3 of 8 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 366335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the nursing progress notes from 01/12/24 to 01/14/24 revealed there was no evidence Resident #98's RLE dressing was changed on 01/12/24, 01/13/24 and 01/14/23. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a RLE skin tear measuring 6.5 cm by 4 cm by 0.1 cm with light drainage. A new blister was noted to the LLE and two new areas below RLE skin tear measuring together. Review of the skin/wound note dated 01/16/24 authored by Agency Licensed Practical Nurse (LPN) #7 revealed Resident #98's RLE and LLE were bruised and bleeding. The resident also had a new vessel to right RLE. The LLE had opened back up and soaked the treatment bandages. Pungent and greenish pale drainage was noted to the RLE and LLE. Review of the nursing progress note dated 01/17/23 revealed WN #1 was in to assess Resident #98. Bilateral lower extremities (BLE) redness chronic to both legs warm to touch, positive pedal pulses to feet (stronger in right foot). RLE skin tear measuring 6.5 cm by 3.5 cm by 0.1 (previous skin tear but due to edema coming and going, area had not resolved) area red with skin flap to wound, scant bloody drainage to skin tear. Two small open areas under skin tear, pink and yellow in color. No drainage or odor noted. Triad (zinc oxide based hydrophilic paste that adheres to moist wound beds and protects periwound skin. Autolytic action loosens dried eschar) applied to two small areas due to yellow to wound. Xeroform to skin tear. Assessment to LLE blister measuring 5.9 cm by 5 cm by unable to examine with scab to top of area. No drainage noted. All areas cleaned, measured and treatment in place. BLE was assessed by nurse practitioner. Appointment made with Vascular for 01/19/24. Recliner placed in room to help keep resident's BLE elevated. Review of the Vascular physician progress note dated 01/19/24 revealed Resident #98 was seen for chronic lower extremity wounds on the shins and in the [NAME] distribution (area below the knee and above the ankle). The resident presented with chronic ulceration on bilateral lower extremities with severe edema in both legs. Resident #98 had pitting edema to bilateral extremities up to high thighs, venous ulcerations on lateral shins bilaterally with bleeding and exposed fat layer. Lower extremity wounds were debrided in the office and cleaned followed by placement of dressings and Unna boot (compression dressing used in the treatment on venous stasis ulcers). Review of the nursing progress note dated 01/19/24 revealed Resident #98 returned from Vascular appointment with Unna boots to BLE. Both legs were saturated with drainage. The nurse called Vascular for follow up orders. Was instructed to remove Unna boot if saturated and apply ABD/Kerlix/Ace wrap. Resident to follow up with Vascular on Tuesday. While at appointment, LLE blister was removed, noted red fresh tissue. Treatment completed to BLE. Review of the physician order dated 01/19/24 revealed to clean BLE with normal saline or wound cleanser, pat dry, apply adaptic/ABD/Kerlix/Ace wrap twice a day. Review of the January 2024 TAR revealed there was no evidence Resident #98's BLE dressing was changed on 01/20/24 during the evening shift. Review of the nursing progress notes from 01/20/24 to 01/21/24 revealed there was no evidence Resident #98's RLE dressing was changed on 01/20/24 during the evening shift. Review of the nursing progress note dated 01/23/24 revealed WN #1 and Wound Nurse Practitioner (WNP) #6 were in to complete treatment to BLE. There were macerated areas to LLE due to drainage and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 4 of 8 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 366335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125 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 0684 treatment was changed. Level of Harm - Minimal harm or potential for actual harm Review of the wound nurse practitioner progress note dated 01/23/24 revealed follow-up for skin tear and new left leg wounds. New ulcer to left leg with red moist base. BLE with large amount of swelling and serous drainage. Periwound with maceration. Resident previously went to Vascular and an Unna boot was applied but there was large amount of serous drainage due to diuresis. Residents Affected - Few Review of the physician order dated 01/23/24 revealed to clean RLE with normal saline, pat dry, apply adaptic/ABD/Kerlix/ace wrap twice a day. Review of the January 2024 TAR revealed there was no evidence Resident #98's RLE and LLE dressings were changed on 01/25/24 during day shift. Review of the Vascular physician progress note dated 01/30/24 revealed Resident #98 presented for a vascular surgery follow-up visit for nonhealing wounds at both lower legs. Resident #98 had lots of drainage from both lower extremities. The LLE venous ulcer measured 4.7 cm by 5.2 cm by 0.1 cm with a large amount of serous drainage. The RLE venous ulcer cluster measured 4.0 cm by 2.5 cm by 0.2 cm with a large amount of serous drainage. Review of the skin care plan updated 02/06/24 revealed Resident #98 had potential for injury development related to disease processes such as diabetes, immobility, incontinence, poor intake, and malnutrition. Resident #98 had skin tear to the right lower extremity (RLE) and a blister to left lower extremity (LLE). Interventions included administering treatments as ordered and monitoring for effectiveness; if the resident refused treatment, staff were to confer with resident, interdisciplinary team and family to try to determine why and try alternative methods to gain compliance, and document alternative methods. Interview on 02/12/24 at 4:30 P.M. with the Director of Nursing, with the Administrator and WN #1 present, verified there was no evidence Resident #98's RLE dressing was changed on 01/12/24, 01/13/24 and 01/14/24. The DON verified there was no evidence Resident #98's BLE dressings were changed on 01/20/24 during evening shift. The DON verified there was no evidence Resident #98's LLE and RLE dressings were changed on 01/25/24 during the day shift. Review of the facility's Wound Care policy revised October 2010 revealed the following information should be recorded in the resident's medical record: the type of wound care given, the date and time the would care was given .if the resident refused the treatment and the reasons why, and the signature and title of person recording the data. This deficiency represents non-compliance investigated under Complaint Number OH00150259. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 5 of 8 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 366335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125 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 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review, policy review and interview, the facility failed to provide preventive care consistent with professional standards of practice to promote healing of a pressure ulcer wound for Resident #98. This affected one (Resident #98) of three residents reviewed for pressure ulcers. The census was 97. Residents Affected - Few Actual harm occurred for Resident #98 when a Stage I pressure ulcer (intact skin with a localized area of non-blanchable erythema/redness) to the resident's coccyx, which was identified on 01/10/24, was noted to have deteriorated to a deep tissue injury (intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration due to damage of underlying soft tissue) on 01/23/24 after the facility did not implement pressure-reducing interventions, did not consistently implement physician wound care orders, did not explore reasoning as to why Resident #98 refused a dressing change, and did not educate Resident #98 on the importance of dressing changes after refusal. Findings include: Review of the closed medical record for Resident #98 revealed an admission date of 12/10/23, discharge date of 02/10/24 with diagnoses of chronic systolic heart failure, diabetes, chronic kidney disease stage three, and chronic atrial fibrillation. Review of the Minimum Data Set (MDS) 3.0 admission assessment dated [DATE] revealed Resident #98 was cognitively intact, required partial/moderate assistance with toileting and rolling left and right in bed and was at risk for developing pressure ulcers. Review of the physician order dated 01/09/24 revealed Resident #98 was to have a pressure redistributing cushion. The order did not indicate where the pressure redistributing cushion was to be placed. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a Stage I pressure ulcer to the coccyx measuring 8 centimeters (cm) by 7 cm by 0 cm. The skin assessment further noted bony area of coccyx. Review of the physician order dated 01/10/24 revealed to clean coccyx with normal saline, pat dry, apply A&D ointment (emollient that protects and moisturizes skin) and large foam dressing daily. Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a Stage I pressure ulcer to the coccyx measuring 6.0 cm by 4.0 cm by 0.0 cm. Review of the January 2024 Treatment Administration Record (TAR) revealed there was no evidence Resident #98's coccyx dressing was changed on 01/13/24, 01/14/24, 01/19/24 and 01/20/24. It was documented Resident #98 refused the coccyx dressing change on 01/21/24. Review of the nursing progress notes from 01/13/24 to 01/20/24 revealed there was no evidence Resident #98's coccyx dressing was changed on 01/13/24, 01/14/24, 01/19/24 and 01/20/24. Review of the nursing progress note dated 01/17/23 authored by Wound Nurse (WN) #1 revealed WN #1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 6 of 8 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 366335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125 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 assessed Resident #98. A recliner was placed in room to help keep Resident #98's bilateral lower extremities (BLE) elevated. Level of Harm - Actual harm Residents Affected - Few Review of the physician orders dated 01/17/24 revealed Resident #98 was to have a recliner in room to assist with keeping BLE elevated when out of the bed. There was no order for a pressure-reducing cushion to be placed on the seat of the recliner. Review of the nursing progress note dated 01/19/24 authored by WN #1 revealed Resident #98 was resting in the recliner with lower extremities elevated. Review of the nursing progress note dated 01/21/24 revealed there was no evidence of why Resident #98 refused the dressing change to his coccyx or evidence of Resident #98 being educated on the importance of the coccyx dressing change. Review of the nursing progress note dated 01/23/24 revealed WN #1 and Wound Nurse Practitioner #6 completed treatment on coccyx and noted purple skin color to coccyx. The note indicated the area was now a deep tissue injury (a deep tissue injury [DTI] results from intense and/or prolonged pressure and shear forces at the bone-muscle interface). Review of the skin documentation assessment dated [DATE] revealed Resident #98 had a suspected DTI to the coccyx measuring 9.0 cm by 9.0 cm by [unable to assess]. The documentation further indicated the coccyx pressure ulcer was now a DTI. Review of the wound nurse practitioner progress note dated 01/23/24 revealed Resident #98 had a pressure ulcer of deep tissue of sacral region of discolored purple area with no drainage measuring 9.0 cm by 9.0 cm by 0.0 cm. Plan included pressure reduction devices. Review of the physician orders dated 01/31/24 revealed Resident #98 was ordered a waffle cushion to the recliner. Review of the pressure ulcer care plan updated 02/06/24 revealed Resident #98 had potential for pressure ulcers related to disease processes such as diabetes, immobility, incontinence, poor intake, and malnutrition. Resident #98 had a Stage I pressure ulcer to the coccyx which changed to a DTI. Interventions included administer treatments as ordered and monitor for effectiveness; if the resident refused treatment, confer with resident, interdisciplinary team and family to try to determine why and try alternative methods to gain compliance; document alternative methods, and waffle cushion to recliner. During an interview on 02/12/24 at 4:30 P.M. with the Director of Nursing (DON), with the Administrator and WN #1 present, the DON verified there was no evidence Resident #98's coccyx dressing was changed 01/13/24, 01/14/24, 01/19/24 and 01/20/24. Interview on 02/13/24 at 12:05 P.M. and 12:36 P.M. with Agency Registered Nurse (RN) #8 revealed on 02/22/24 when RN #8 completed the dressing change, Resident #98's coccyx was not red. RN #8 described Resident #98's coccyx as having an oval-shaped area with a dark purplish/bruising color. Agency RN #8 would have classified the coccyx wound as DTI. RN #8 did not report the suspected DTI because she was not aware it was a change from the previous assessment/classification. Interview on 02/13/24 at 1:35 P.M. with Agency Licensed Practical Nurse (LPN) #9 confirmed she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 7 of 8 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 366335 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Snf-the Villa at Marymount 5200 Marymount Village Drive Garfield Heights, OH 44125 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 worked at the facility on 01/21/24 however Agency LPN #9 did not remember Resident #98. Level of Harm - Actual harm A follow-up interview on 02/13/24 at 2:05 P.M. with the DON (with WN #1 and Administrator present) verified there was no evidence a pressure-reduction cushion was placed in the seat of Resident #98's recliner until 01/31/24 and there was no evidence of why Resident #98 refused the coccyx dressing change or was educated on the importance of the dressing change on 01/21/24. The DON, Administrator and WN #1 verified Resident #98's coccyx worsened from a stage one pressure injury to a DTI between 01/19/24 to 01/23/24. Residents Affected - Few Interview on 02/20/24 at 10:30 A.M. with Physician #10 revealed although he signed a form indicating Resident #98 had an unavoidable coccyx pressure ulcer on 01/25/24, Physician #10 was not aware Resident #98's coccyx dressing change was not completed on multiple, consecutive days. Physician #10 was not aware Resident #98 was not educated regarding the risks of refusing the dressing change or the benefits of the daily wound care and assessment after refusing the coccyx dressing change. In addition, Physician #10 was not aware a pressure reduction cushion was not placed in the recliner when Resident #98 began to use the chair but was placed in the chair on 01/31/24, eight days after the DTI was discovered. Review of the facility's Wound Care policy revised October 2010 revealed the following information should be recorded in the resident's medical record: the type of wound care given, the date and time the wound care was given .if the resident refused the treatment and the reasons why, and the signature and title of person recording the data. This deficiency represents non-compliance investigated under Complaint Number OH00150259. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366335 If continuation sheet Page 8 of 8