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. Page 1 of 3 366477 366477 09/18/2023 Avenue at North Ridgeville 6200 Lear Nagle Road North Ridgeville, OH 44039

F 0686 Level of Harm - Minimal harm or potential for actual harm During interview on 08/29/23 at 10:04 A.M., the DON state she had contacted Licensed Practical Nurse (LPN #230), whose initials were on the dressing. LPN #230 stated she had placed the dressings on Resident #50's heels on 08/07/23 as a preventive measure. Resident #50's feet and heels were observed with the dressings removed on 08/29/23 with no concerning areas. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00145394. 366477 Page 2 of 3 366477 09/18/2023 Avenue at North Ridgeville 6200 Lear Nagle Road North Ridgeville, OH 44039

F 0777 Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure X-ray results were communicated to the physician. This affected one (Resident #97) of three sampled residents. The facility census was 72. Residents Affected - Few Findings include: Record review revealed Resident #97 was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy, congestive heart failure, atrial fibrillation and history of falling. Review of the progress notes dated 07/27/23 at 6:26 A.M. documented the nurse was notified by the State Tested Nursing Assistant (STNA) that Resident #97 was found on lying on the right side on the floor near the bathroom. Resident #97 was complaining of pain to the right wrist. The physician was notified and an X-ray was ordered for the wrist. Review of the X-Ray report dated 07/27/23 at 9:47 P.M. revealed Resident #96 had an acute nondisplaced fracture of the distal radius with intra-articular extension to the radiocarpal joint. Carpal alignment remains normal. There is adjacent soft tissue swelling. The final impression was a fracture of the distal radius with intra-articular extension to the radiocarpal joint. The physician was not notified of the results until 07/29/23 at 6:20 P.M., when Resident #97 was sent to the hospital. Progress notes dated 07/29/23 at 6:20 P.M. identified Resident #97 was sent to hospital for a fractured right wrist. This deficiency was based on incidental findings discovered during the course of this complaint investigation. 366477 Page 3 of 3