Health inspection·October 11, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interview with staff, it was determined that the facility failed to provide wound treatment related to a resident's wound for one of two residents reviewed. (Resident R1) Residents Affected - Few Findings include: Review of Resident R1's clinical record revealed that Resident R1 was admitted to the facility on [DATE] with the diagnoses of Peripheral Vascular Disease (a systemic disorder that involves the narrowing of peripheral blood vessels) and open wound on the lower leg. Review of Resident R1's quarterly MDS (Minimum data set-a federally required resident assessment completed at a specific interval) dated September 15, 2023, revealed that Section C0500 BIMS (brief interview for mental status) scored 13 suggesting that Resident R1 was cognitively intact. Review of MDS section M (skin conditions) revealed that Resident R1 was at risk for pressure ulcer, had venous or arterial ulcers and skin tears. Further review of Resident R1's quarterly MDS dated [DATE], section M1200 (I) Application of dressing to feet (with or without topical medications) was coded NO indicating that resident did not have dressing applied to his feet during the observation period of the MDS assessment. Review of clinical documentation from the wound clinic dated September 1, 2023, revealed a recommendation to change band aid on left foot toe daily with an antibiotic ointment and a bandaid. Review of Resident R1's documentation from the wound clinic dated September 15, 2023, revealed a recommendation to wash toes on both feet daily. Please change the left foot dressing daily with Aquacel Ag and gauze until the drainage decreases. Review of Resident R1's Treatment Administration Record for September 2023 revealed a treatment as follow: Cleanse left foot great & 2nd toes wound w/cleanser, apply calcium alginate and gauze and kling wrap until the drainage decreases every day shift for wound care with discontinue date of Septemebr 20, 2023. Further, there were no licensed nurse initial/signature indicating that the treatment was performed thoughout the duration of the treatment for the month of September 2023. Review of Resident R1's physician's order dated September 20, 2023, revealed an order for: Cleanse left foot great & 2nd toes wound w/cleanser, apply Xeroform and gauze 4x4 and kling wrap until the drainage decreases every day shift for wound care and as needed for wound care soiled/missing Page 1 of 2 395193 395193 10/11/2023 Rosemont Center 35 Rosemont Avenue Rosemont, PA 19010

F 0684 dressing. Level of Harm - Minimal harm or potential for actual harm Review of Resident R1's Treatment Administration Record for September 2023 revealed that on September 20, 2023, treatment on resident was started as follow: Cleanse left foot great & 2nd toes wound w/cleanser, apply Xeroform and gauze 4x4 and kling wrap until the drainage decreases every day shift for wound care and as needed for wound care soiled/missing dressing. Residents Affected - Few Further review of the Resident R1's clinical record revealed that there was no documented evidence that Resident R1 received treatment to left foot great toe and second toe until September 20, 2023. Interview with Director of Nursing conducted on October 12, 2023, at 12:43 am confirmed that on September 8, 2023, the physician at the wound care clinic recommended the following treatment for Resident R1 wash toes on both feet daily. Please change the left foot dressing daily with Aquacel Ag and gauze until the drainage decreases and that there were no physician's orders for the recommended treatment. Further Director of Nursing also confirmed that there no were physician's orders for treatment of Resident R1's wounds on his left foot great toe and second toe until September 20, 2023, and that Resident R1 did not receive treatments to his left lower foot great toe and second toe until September 20, 2023. 28 Pa. Code 211.12(d)(1) Nursing services 28 Pa. Code 211.12(d)(5) Nursing services 395193 Page 2 of 2