Health inspection·October 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 a review of clinical and hospital records and staff interviews, it was determined that the facility failed to ensure wound treatment was initiated upon admission for two of the six residents reviewed (Resident 149 and 151). Residents Affected - Few Findings include: Review of Resident 149's nursing progress notes dated October 13, 2023, revealed resident was admitted to the facility from the hospital with a diagnosis of Congestive Heart Failure (CHF-weakened heart condition that causes fluid buildup in the feet, arms, lungs, and other organs). Review of Resident 149's admission assessment, dated October 13, 2023, revealed resident was admitted with a Deep Tissue Pressure Injury (persistent non-blanchable deep red, maroon, or purple discoloration) to the coccyx (tail bone). Further review of Resident 149's clinical record failed to reveal, a wound treatment was completed on Resident 149's coccyx DTI until October 16, 2023; three days after resident was admitted to the facility and assessed with a DTI to the coccyx. Interview conducted with the wound nurse, licensed nurse Employee E4 on October 20, 2023, at 10:00 a.m., revealed that upon the resident's admission, the resident ' s skin will be assessed by an RN (Registered Nurse). Identified skin impairment will be reported to the physician, an order will be made, and wound treatment will be initiated. Employee E4 confirmed that a wound order treatment was not placed upon resident admission and wound treatment was not done until October 16, 2023, three days after a resident was admitted and a skin impairment was identified. Review of Resident 151's hospital records, and Discharge summary dated [DATE], revealed resident had a stage three (Full-thickness skin loss) to the right ischium/buttock wound). Recommended wound treatment was Aquacel ag (anti-microbial dressing used in wounds that are infected or at risk for infection) to wound, covered with foam dressing daily. Review of Resident 151's clinical records and admission assessment revealed resident was admitted to the facility on [DATE], with a stage two to the right buttock, measuring 4.0 x 2.0 x 0.1 cm. Review of the physician's order dated October 14, 2023, revealed a wound treatment order was made to cleanse the right ischium/buttock with normal saline solution, pat dry, apply Aquacel ag and cover with a foam dressing. (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 2 Event ID: 396062 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 396062 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inn at Freedom Village,the 35 Freedom Boulevard West Brandywine, PA 19320 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)