Health inspection·May 4, 2023

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 record review, interview and observation, the facility failed to ensure care and services for pressure ulcers/injuries were provided according to professional standards of practice including documenting appropriate wound care orders and performing wound care according to physician orders for Resident #7 and #58. This affected two residents (#7 and #58) of three residents reviewed for wound care. The census was 65. Residents Affected - Few Findings include: 1. Record review of Resident #7 revealed she was admitted [DATE] and had diagnoses including atrial fibrillation, bipolar disorder, and peripheral vascular disease. Review of the most recent wound assessments, dated 04/26/23, said she had an unstageable pressure sore (full thickness tissue loss exposing tendon, muscle or bone) to her right heel and to her lateral right foot which were to receive daily care and dressing changes, and a deep tissue injury (discolored, intact skin) to her coccyx which were to receive three dressing changes per week. Review of her physician orders and treatment administration record (TAR) revealed no active orders for any wound care for Resident #7, and no documentation any dressing changes were done. Interview with Clinical Nurse Practitioner (CNP) #601 on 05/03/23 at 12:13 P.M. confirmed Resident #7 had no wound care orders in place. She initially saw the resident the prior week and gave orders for regular wound care. Observation of a wound care procedure for Resident #7 on 05/03/23 at 1:10 P.M. with CNP #601 and Registered Nurse (RN) #602 revealed the dressing on her right foot (covering both the right heel and lateral right foot wounds) was dated 04/29/23. The deep-tissue injury on her coccyx had no bandage in place. The surveyor confirmed these findings with CNP #601 and RN #602 during the procedure. 2. Record review of Resident #58 revealed she was admitted [DATE] and had diagnoses including osteomyelitis, anemia, peripheral vascular disease, and diabetes. Review of the most recent wound assessments, dated 04/26/23, noted she had a vascular wound on her right foot and treatment was to include Xeroform (a nonadhesive occlusive dressing), a vascular wound on her left foot, and a stage IV pressure sore (a wound extending beneath the subcutaneous layer) on her coccyx and treatment was to include calcium alginate. These wounds were all documented as being present on admission. Review of the physician orders for Resident #58 revealed order for the coccyx dressing made no Page 1 of 2 366441 366441 05/04/2023 Seven Hills Health & Rehab Center 819 Rockside Road Seven Hills, OH 44131

F 0686 mention of applying calcium alginate. Level of Harm - Minimal harm or potential for actual harm Observation of a wound care procedure for Resident #58 on 05/03/23 at 12:22 P.M. with CNP #601 and RN #602 revealed the prior wound dressing being removed from the right foot had no Xeroform in place. The wound on the coccyx had Xeroform and calcium alginate in place, which CNP #601 said was correct and matched the orders she gave. Residents Affected - Few Interview with CNP #601 immediately following the procedure confirmed the right foot wound should have had Xeroform in place, and the current order for the coccyx wound did not indicate alginate was to be applied to the dressing. Review of the facility wound policy dated 06/10/22 revealed wounds were to be treated with evidence-based interventions as ordered by the provider. This deficiency represents noncompliance investigated under OH00142096. 366441 Page 2 of 2