Inspection·April 19, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observations, review of clinical records and interview with staff, it was determined that the facility failed to ensure that pressure ulcer prevention measures were followed as ordered by the physician for one of one resident with pressure ulcer reviewed. (Resident R69) Residents Affected - Few Findings include: Review of facility's policy 'Prevention of Pressure Ulcers,' indicates that when in bed, every attempt should be made to 'float heels' (keep heels off of the bed) by placing a pillow from knee to ankle or with other devices as recommended by therapist and prescribed by the physician. Review of Resident R69's clinical records revealed past medical history of cerebral infarction, anoxic brain damage, persistent vegetative state, anemia, long-term anticoagulant use, gastrostomy status, and ventilator status. Review of February 2024 physican orders revealed an order revised on February 8, 2023 to wear prevalon boots to BLE (bilateral legs) at all times except for hygiene or skin checks. Continued review of physician orders revealed another order dated April 15, 2022 to off load heels with pillows while in bed as tolerated. Review of R69's care plan revealed R69 has a history of impaired skin integrity related to cognitive deficit, fragile skin, limited mobility and chronic disease process with interventions such as to follow facility protocols for treatment of injury. Review of 'wound evaluation and management summary' from March 28, 2024 revealed stage 3 pressure wound of the right heel full thickness, etiology - pressure; re-opening of stage 3. Recommendations to off-load wound; reposition per facility policy; float feels in bed. Review of progress notes by wound care nurse, Employee E35, dated March 27, 2024 at 2:57 pm revealed Resident noted with stage 3 reopened pressure ulcer of Right heel. Area measures 4cm x 3cm with depth of 0.1cm. 100% granulating tissue . No S/S (signs and symptoms) of infection noted . Dependent on staff for bed mobility and repositioning. Resident has severe contractures of B/L lower extremities. ON FMP program for Prom and offloading of wedges and pillows between knees. Feet was not off loaded or prevalon boots on resident@ time of discovery. Further review of progress notes dated April 11, 2024 at 9:07 am revealed no improvement noted to stage 3 right heel wound. Continue with current treatment as ordered. Another progress note dated April 12, 2024 at 9:53 am revealed R69 was seen by nurse practitioner, (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 13 Event ID: 395019 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 395019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aristacare at Meadow Springs 845 Germantown Pike Plymouth Meeting, PA 19462 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)