Health inspection·November 14, 2024

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 observations, review of the medical record and interview with staff the facility failed to ensure the air mattress for Resident #26 was set at the proper setting for her weight and the treatment for Resident #55 was completed as ordered. This affected two residents ( #26 and #55) of four residents reviewed for wounds. The facility census was 99. Residents Affected - Few Findings included: 1. Review of the medical record revealed Resident #26 was admitted to the facility on [DATE]. Diagnoses included Parkinson's disease, muscle weakness, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension, stage four pressure ulcer of sacral region, neuromuscular dysfunction of bladder, arthritis, diabetes, (DM) hypothyroidism, moderate protein-calorie malnutrition, bladder-neck obstruction, dysphagia, pruritus, peripheral vascular disease (PVD), generalized anxiety disorder, anemia, bipolar disorder, major depressive disorder, restless leg syndrome, breast cancer and gastro-esophageal reflux disease (GERD). Review of the care plan dated 06/05/23 revealed Resident #26 had a pressure injury to her coccyx related to impaired mobility, PVD, diabetes, bowel incontinent, COPD, breast cancer, poor nutrition, friction concerns, and shearing concerns. Interventions included an air mattress to her bed. Review of the physician's order dated 07/07/24 revealed Resident #26 had on order for an air mattress to the bed, check the placement and function every shift. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 had intact cognition. Review of Resident #26's weight dated 11/12/24 revealed a weight of 118.6 pounds. Review of the operations manual for the Drive alternating pressure low air loss mattress revealed on page seven, step six of the operation instruction revealed the resident's weight must be determined and to set the control knob to the weight setting on the control unit. Observation of the air mattress setting for Resident #26 on 11/12/24 at 2:40 P.M. revealed the air mattress was set at 300 pounds. During an interview at the time of the observations, Registered Nurse #504 confirmed the settings were incorrect and Resident #26 did not weigh 300 pounds. On 11/13/24 at 2:42 P.M. an interview with Resident #26 revealed she weighed 118 pounds the last time they weighed her. (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: 366429 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 366429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare Zanesville Inc. 4200 Harrington Drive Zanesville, OH 43701 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)