Health inspection·November 17, 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 observation, resident interview, staff interview, medical record review, and policy review, the facility failed to implement care planned interventions for nutritional supplements for Resident #60 to maximize the healing potential of wounds. This affected one resident (#60) of three reviewed for wounds. The facility census was 63.Findings Include:Review of the medical record for Resident #60 revealed an admission date of 08/28/25. Pertinent diagnoses included: hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, chronic kidney disease stage 4 (severe), acute kidney failure, depression, anxiety disorder, muscle weakness, pressure ulcer of sacral region, unspecified stage; pressure ulcer of left heel, unspecified stage, and obesity.Review of the admission Minimum Data Set (MDS) dated [DATE] revealed Resident #60 had moderately impaired cognition. The resident was at risk for developing pressure ulcers and she had three stage 4 pressure ulcers on admission.Review of the initial wound evaluation and management summary dated 08/29/25 revealed Resident #60 had a stage 4 pressure wound on her sacrum measuring 13 centimeters (cm) by 9.5 cm by 1 cm and a stage 4 pressure wound of the left heel partial thickness measuring 1.3 cm by 1.7 cm by 0.2 cm. The report recommended a dietary consultation due to resident's body mass index (BMI). Review of the plan of care entry dated 09/04/25 revealed the resident had three pressure injuries located on the left ischium (pelvis), sacrum and left heel. Interventions included: continue with preventative care plan measures to prevent further skin breakdown, nutritional status assessment, observe wound for any redness, warmth, drainage, odor and report to physician as needed, observe/report any non-compliance/rejection of care for wound management, perform treatment as ordered. Additionally, there was care plan entry noting resident was at risk for skin breakdown due to impaired mobility, impaired cognition, bowel incontinence, hemiplegia (weakness), renal disease, poor nutritional intake and anemia.Review of the plan of care entry dated 09/09/25 revealed Resident #60 was at risk for altered nutrition due to their diagnoses, that their intake was low and they were on a regular diet. The dietician noted the resident's wounds and recommended prosource (protein) for wound healing. Interventions included: Offer menu alternatives, monitor weight weekly and then monthly if stable, to provide diet per physician order and supplements per physician order. Review of the Wound Evaluation and Management Summary Report from 09/16/25 revealed Resident #60's stage 4 pressure wound to the sacrum was 11 cm by 12 cm by 1.5 cm with moderate serous exudate. Her left heel full thickness was 1 cm by 0.6 cm by 0.2 cm with moderate serous exudate.Review of the Wound Evaluation and Management Summary Report from 10/21/25 for Resident #60 revealed the stage 4 pressure wound to the scrum full thickness was 11 cm by 10 cm by 2.5 cm with moderate serous exudate. The wound progress was evaluated to be exacerbated due to unknown. The pressure wound of the left heel full thickness was 2.5 cm by 1.8 cm by 0.3 cm with moderate serous exudate. Review of physician orders for September 2025 and October 2025 identified no orders specific to prosource for wound healing.Review of weight records for Resident #60 revealed a weight of 164.2 pounds 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 2 Event ID: 366367 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 366367 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Canal Winchester Post-Acute Rc 6725 Thrush Drive Canal Winchester, OH 43110 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)