Inspection·July 1, 2024

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 clinical records review and staff interview, it was determined that the facility failed to ensure wound treatment and assessment were completed and recommendation of a wound physician was followed for three of eight residents reviewed (Residents 83, 87, and 242). Residents Affected - Some Findings include: Review of Resident 83's clinical records revealed that the resident was admitted to the facility on [DATE], with a diagnosis of Bladder Cancer and duodenal ulcer with surgical treatment. Revie of Resident 83's clinical record revealed resident was admitted with a Stage 2 Pressure Ulcer (Partial-thickness skin loss with exposed dermis) to the lower back with a measurement of 3.7 x 1.2 cms. The wound was treated with normal saline and then covered with an Optifoam (silicone-bordered dressing) dressing every three days. Review of Resident 83's clinical record revealed a wound consult dated June 11, 2024, indicating the lower back/lumbar spine wound was an Unstageable Pressure Ulcer (Obscured full-thickness skin and tissue loss), with a measurement of 1.3 x 0.6 x 0.1 cms. With 100 % slough. The physician recommended cleansing the wound with cleanser, applying Medihoney, and cover with Silicone dressing daily. Review of Resident 83's clinical record revealed the Medihoney treatment recommended by the wound physician was not implemented until June 27, 2024, 16 days after the recommended treatment was made on June 11, 2024. During that time the unstageable wound to the lower back/lumbar spine was treated with Optifoam dressing every three days. Interview with the Director of Nursing (DON) conducted on July 1, 2024, revealed, after a resident is seen by the wound physician, the unit manager was responsible for reviewing the recommendations and notifying the primary physician of the order. The DON reported that the unit manager was not able to relay the wound care treatment recommendation to the primary physician therefore wound treatment was not changed to Medihoney until June 27, 2024. The facility failed to ensure wound physician's recommendation for wound treatment of Resident 83's unstageable wound to the lower back was followed. Review of Resident 87's Progress Notes revealed a nursing entry dated June 6, 2024 at 7:54 p.m. stating Resident noted with B/L (bilateral-both) heel DTI (Deep Tissue Injury- deep red, purple or maroon areas of intact skin, non-intact skin or blood-filled blisters caused by damage to the underlying soft tissues). (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 4 Event ID: 395332 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 395332 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wayne Center 30 West Avenue Wayne, PA 19087 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)