Inspection·April 20, 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 clinical record review, observation, staff interview, and resident interview, it was determined that the facility failed to implement interventions to prevent pressure ulcers for one of three sampled residents with pressure sores. (Resident 9) Residents Affected - Few Findings include: Clinical record review revealed that Resident 9 had diagnoses that included generalized muscle weakness, arthritis of the right knee, and a pressure ulcer of the left heel. The Minimum Data Set assessment dated [DATE], indicated that the resident was oriented and required staff assistance with activities of daily living, including dressing. The care plan identified that the resident had the potential for skin breakdown related to immobility. Review of the consulting wound physician's report dated April 13, 2023, revealed that orders included that Resident 9 keep wearing Prevalon boots (boots with a cushioned bottom to prevent pressure) on both feet. Nursing documentation dated April 14, 2023, also noted that the resident was to wear Prevalon boots on both feet. Resident 9 was observed on April 19, 2023, at 2:11 p.m., and April 20, 2023, at 1:40 p.m. seated in the wheelchair wearing a pressure relieving boot on the left foot and only a sock on the right foot. Both feet were placed on and in contact with a wheelchair foot rest. In an interview on April 20, 2023, at 1:40 p.m., Resident 9 reported that staff do not always apply the boot for the right foot and that it was available in the closet. The resident denied refusing to wear the right boot. During an interview on April 20, 2023, at 1:47 p.m., the nurse aide (NA 1) reported that the resident had an order to wear a pressure relieving boot on the left foot only and stated that the resident had only one boot available. Observation on April 20, 2023, at 1:50 p.m., revealed that a second pressure relieving boot was in Resident 9's closet. 28 Pa. Code 211.12(d)(1)(5) Nursing services. 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: 395752 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 395752 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Moravian Hall Square Health and Wellness Center 175 West North Street Nazareth, PA 18064 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)