Arc At Hickory Point

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to identify and report an alteration in skin integrity to prevent a pressure ulcer for one (R1) of four residents reviewed for quality of care.

This failure resulted in R1 developing a Stage 2 pressure ulcer to the middle of R1's tailbone.Findings include:The facility's Skin Condition Assessment & Monitoring - Pressure and Non-Pressure Policy, dated 04/2025, documents that the purpose of the policy is to establish guidelines for assessing, monitoring, and documenting the presence of skin breakdown, pressure injuries, and other non-pressure skin conditions, and ensuring interventions are implemented.R1's Care Plan, initiated on 05/22/2019, documents that R1 is at risk for developing pressure ulcers and other impairments to skin integrity related to decreased mobility, pain, and weakness.

This Care Plan includes an intervention dated 05/23/2019 for monitoring, reminding, and assisting to turn/reposition R1 at least every two hours, more often as needed or requested, and to notify R1's nurse immediately of any new areas of skin breakdown noted during bathing or daily care.R1's CNA (Certified Nurse Assistant) Skin Attention Form (completed by CNA during resident bath) from 09/01/2025 through 10/01/2025 does not document any skin issues.R1's Comprehensive Incident Fall assessment dated [DATE] documents a skin tear on R1's tailbone measuring 4.2 centimeters (cm) by 3.1 cm.R1's Hospice Plan of Care Update Report dated 10/04/2025 documents that R1 had a pressure ulcer/pressure injury to the tailbone area.On 10/09/2025 at 9:52 AM, V14, Assistant Director of Nursing (ADON), stated she was not aware that R1 had a sore on her tailbone until it was found the morning of R1's fall on 09/27/2025, and that the area on R1's tailbone did not have the appearance of a skin tear.On 10/09/2025 at 12:36 PM, V5, Licensed Practical Nurse (LPN), stated the CNAs are responsible for checking on residents every two hours and repositioning them.

She stated R1 preferred to be up in her geriatric chair and that she sits in it most of the day.

She also stated that she did not know how one would be expected to reposition a resident who sits in a geriatric chair.On 10/09/2025 at 1:51 PM, V23, Registered Nurse (RN - Hospice), stated that during R1's initial Hospice assessment on 10/04/2025, she discovered a pressure ulcer on R1's tailbone area that was the size of an egg, 0.1 cm in depth, deeper than skin, and pale in color.R1's Wound Care visit report dated 10/07/2025 documents that R1 had a Stage 2 pressure ulcer in the middle of R1's tailbone measuring 6.5 cm by 5.5 cm by 0.1 cm in depth.On 10/09/2025 at 2:39 PM, V24, Doctor of Nursing Practice (DNP - Wound Care), stated he saw R1 on 10/07/2025 and that the area on R1's tailbone was a pressure ulcer, not a skin tear. By the appearance of the wound, it had developed three to four weeks prior and was not caused by R1's fall on 09/27/2025.

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

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/14/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Arc at Hickory Point

565 West Marion Avenue Forsyth, IL 62535

SUMMARY STATEMENT OF DEFICIENCIES