Health inspection·December 10, 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 observation, medical record review, policy review and interview, the facility failed to maintain care and services for pressure ulcers. This affected one (#38) resident observed for a pressure ulcer dressing change. The facility identified five residents with pressure ulcers. The census was 92. Residents Affected - Few Findings include: Medical record review revealed Resident #38 was admitted on [DATE] with diagnoses including paraplegia and Stage IV (Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer) pressure ulcer to the left ischium. Review of the Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #38 was cognitively intact for daily decision-making and had a Stage IV pressure ulcer. Review of the care plan: Pressure Injury (revised 10/10/24) revealed to complete treatments as ordered. Review of the electronic Physician Orders dated December 2024 revealed left gluteal cleft cleanse with Dakin's, apply Dakin's soaked kerlix gauze and cover with dressing. The treatment was to be completed daily. On 12/09/24 between 2:53 P.M. and 3:12 P.M. observation of Resident #38's left ischium pressure ulcer dressing change revealed the following: Registered Nurse (RN) #398 entered Resident #38's room with gathered pressure ulcer dressing change supplies. RN #398 prepared a clean field on the overbed table with prepoured Dakin's Solution 0.125%, kerlix, gauze, hand sanitizer and gloves. RN #398 removed a pair of bandage scissors from his scrub top pocket and cleaned the scissors with an alcohol swab. RN #398 used the bandage scissors to cut the kerlix and returned the bandage scissors to his scrub top pocket. Resident #38 was laying in bed and was assisted to his right side to expose the left ischium. The left ischium was not covered with a dressing, wound packing could be observed coming from the wound and a drainage collection bag with yellow urine was observed under the resident. RN #398 verified a dressing was ordered to cover the wound to absorb drainage, protect the wound and the resident should not have been laying on the drainage collection bag. RN #398 looked in the bed and through the linens and no dressing was found. RN #398 removed the packing from the wound and cleaned the wound. RN #398 removed his soiled gloves, used hand sanitizer, and applied new gloves. RN #398 soaked the cut kerlix roll in a cup of Dakin's solution and then packed the wound; however, there was an excess of Dakin's soaked gauze extending from the wound. RN #398 put his gloved hand into his scrub shirt pocket, removed the bandage scissors and used the scissors to cut the kerlix. At the time of the observation Assistant Director of Nursing #404 asked RN #398 if those were clean and he stated yes. RN #398 did not removed his gloves/hand wash after putting his gloved hand in his scrub shirt pocket to obtain the bandage scissors. RN #398 covered the wound with a dermaright dressing, assisted (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: 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 12/10/2024 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)