Inspection·September 26, 2025

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 review, the facility failed to ensure newly identified wounds were timely assessed and measured, and failed to ensured proper treatment timely implemented. This affected one (#20) of three residents reviewed for pressure ulcers. The facility census was 55. Findings include:Review of the medical record revealed Resident #20 was admitted on [DATE]. Diagnoses included spastic diplegic cerebral palsy, chronic kidney disease stage III, chronic respiratory failure with hypoxia, essential hypertension, mixed hyperlipidemia, hyperglycemia, and hypertensive chronic kidney disease.Review of the Minimum Data Set (MDS) assessment, dated 06/25/25, revealed Resident #20 was severely cognitively impaired and was at risk of pressure ulcers. Review of the care plan, updated 09/23/25, revealed Resident #20 had actual impaired skin integrity due to bilateral stage two pressure wounds (partial-thickness skin loss with exposed dermis) and was at potential risk for skin breakdown due to incontinence, weakness, and impaired mobility. Review of Resident #20's physician orders, dated 09/04/24, revealed an order to apply barrier cream two times a day for skin protection as needed.Review of nursing progress notes dated 09/06/25 revealed Resident #20 had a small open sore on the right buttock. The physician was notified via the communication book.Review of the weekly skin observation tool, dated 09/06/25, revealed Resident #20 had a small open sore on the right buttock. Further review revealed there was no assessment of the wound, no measurements, and no description of the wound documented. Review of nursing progress notes dated 09/12/25 revealed Resident #20 had two open sores on the bilateral upper buttocks and an order was placed for barrier cream twice a day and as needed. Review of the weekly skin observation tool dated 09/12/25 revealed Resident #20 had an open sore on bilateral upper buttocks. The wounds were described as small open sores to the upper bilateral buttocks with no further description of wound, assessment, or measurements included. Review of a wound physician evaluation and management summary dated 09/18/25 revealed Resident #20 had a stage two pressure ulcer on the left buttock measuring 1.0 centimeters (cm) long by (x) 0.5 cm wide x 0.1 cm deep. Resident #20 also had a stage two pressure wound to the right buttock measuring 0.4 cm long x 0.5 cm wide x 0.1 cm deep. Review of a physician order dated 09/18/25 revealed an order to apply triad hydrophilic wound dressing external paste to Resident #20's buttocks topically two times a day for a stage two pressure wound. Review of the wound physician evaluation and management summary dated 09/25/25 revealed Resident #20 had a stage two pressure ulcer on the left buttock measuring 0.5 cm long x 0.3 cm wide x 0.1 cm deep. The wound healing progress was described as improved with a decreased surface area. The state two wound of the right buttock was resolved. Interview on 09/26/25 at approximately 11:00 A.M. with the Director of Nursing (DON) verified there was no description or wound measurements completed of Resident #20's wounds. Interview on 09/26/25 at 1:28 P.M. with the DON verified the physician should have been called on 09/06/25 when a new open area was found.Review of a policy titled, Skin Care Management, revised 11/17/22, revealed the facility will implement, Residents Affected - Few (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: 366361 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 366361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Monclova 5069 Otterbein Way Monclova, OH 43542 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)