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F0686
D

Failure to Implement Wound Care Orders for Pressure Ulcer

Gettysburg, Pennsylvania Survey Completed on 06-12-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency was identified when a resident with diagnoses including cervicalgia and acute diastolic congestive heart failure developed a stage 1 pressure ulcer on the right buttock. The resident was evaluated by a contracted wound care provider, who recommended daily treatment with a superabsorbent gelling fiber with silicone border. However, a review of the clinical record and physician orders revealed that the recommended wound care orders were not entered for the resident's pressure ulcer. This omission resulted in the resident not receiving the necessary treatment and services consistent with professional standards of practice to promote healing and prevent infection, as required by facility policy and regulation.

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