Inspection·April 18, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm Based on medical record review, observation, staff interview, review of facility policy, and review of guidelines from the National Pressure Ulcer Advisory Panel (NPUAP), the facility failed to adequately assess and monitor a resident's skin which resulted in Actual Harm for Resident #20 who was admitted to the facility without pressure ulcers and developed a stage three pressure ulcer (a full thickness skin break into the subcutaneous tissue which did not go into muscle or bone) to the right ischium which was not identified until it had reached an advanced stage. This affected one (Resident #20) of three residents reviewed for pressure ulcers. The facility census was 113. Residents Affected - Few Findings include: Review of the medical record for Resident #20 revealed an admission date of 02/29/20 with diagnoses including Alzheimer's disease, anemia, atherosclerotic heart disease of coronary artery, and hypertension. Review of the care plan for Resident #20 dated 02/12/24 revealed the resident had potential for skin impairment related to impaired mobility, fragile skin, and incontinence. Interventions included the following: assist as needed with toileting and hygiene, staff to apply barrier cream as needed after incontinent episodes, staff to check skin daily while doing routine care and report changes to the nurse, staff to apply pressure reducing mattress to bed. Review of the pressure ulcer risk assessment for Resident #25 dated 02/25/24 revealed the resident was at moderate risk for the development of pressure ulcers. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #20 dated 02/27/24 revealed the resident was cognitively impaired and dependent with eating, toileting, bathing, dressing, and transfers. Resident #20 was at risk for the development of pressure ulcers but did not have pressure ulcers. Review of the wound progress note for Resident #20 dated 03/20/24 per Wound Nurse Practitioner (WNP) #70 revealed the resident had developed an in-house acquired stage three pressure ulcer to the right ischium first observed by the staff on 03/19/24 which measured 2.0 centimeters (cm) in length by 2.0 cm in width by 0.8 cm in depth. The wound bed was yellow, pink and red with granulation tissue present and moderate amounts of serous and serosanguineous drainage noted. Treatment recommended was to apply alginate to the wound bed. Review of the physician's orders for Resident #20 revealed an order dated 03/20/24 to cleanse the pressure ulcer to the right ischium with normal saline, pat dry, apply calcium alginate and cover with abdominal pad and retention tape. (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 4 Event ID: 366380 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 366380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indianspring of Oakley 4900 Babson Place Cincinnati, OH 45227 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)