Health inspection·September 18, 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 observations, record review and staff interview, the facility failed to ensure residents had treatment orders for wounds and failed to ensure dressing changes were completed as ordered. This affected two (Residents #50 and #96) of three sampled residents. The facility census was 72. Residents Affected - Few Findings include: 1. Record review revealed Resident #96 was admitted to the facility on [DATE], with diagnosis including sepsis from a pressure ulcer, end stage renal disease, diabetes, pulmonary embolism, colostomy, gastrostomy and tracheostomy. Review of Wound Physician #370's progress notes revealed he evaluated Resident #96's wounds in the facility on 07/21/23 at 7:25 A.M. The notes documented Resident #96 was admitted the day prior, 07/20/23, with physician orders for a wound vacuum to the sacral area. Wound Physician #370 documented the wound vacuum would be contraindicate, due to eschar, bleeding and possible bone involvement. There was an order to pack the coccyx wound with Dakin's soaked gauze (3 rolls) for a wet to moist dressing and cover with an absorbent dressing. Review of the physician orders revealed the order for the wound treatment was not entered into the facility's computer system until 07/23/23, two days later. There was no documented evidence a treatment to the coccyx wound was completed on 07/21/23 or 07/22/23. During interview on 08/29/23 at 10:22 A.M., the DON verified Resident #96 was admitted on [DATE] with several pressure ulcers. She conformed the treatment orders were not entered into the computer system until 07/23/23 and no treatment to the coccyx wound was completed on 07/21/23 or 07/22/23. 2. Record review revealed Resident #50 was admitted on [DATE] with medical diagnosis including anoxic brain injury, persistent vegetative state and uncontrolled asthma. During observation 08/29/23 at 7:39 A.M., Resident #50 had dressings to both feet, wrapped around each ankle. The dressing had tape closure that was dated 08/07/23 with initials. Resident #50's feet and heels were elevated off the mattress. Review of Resident #50's physician orders revealed no current or previous physician orders for dressing to his feet. During interview on 08/29/23 at 8:04 A.M., the Director of Nursing (DON) verified Resident #50 had dressings to his feet dated 08/07/23, which was 23 days ago. (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 3 Event ID: 366477 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 366477 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at North Ridgeville 6200 Lear Nagle Road North Ridgeville, OH 44039 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)