Aperion Care Marion Llc

F-F801 of the State Operations Manual, S483. 60(a)(2). 'If a qualified dietitian or other clinically qualified nutrition professional is not employed fulltime, the Residents Affected - Some facility must designate a person to serve as the director of food and nutrition services. (i) The director of food and nutrition services must at a minimum meet one of the following qualifications- (A) A certified dietary manager; or (B) A certified food service manager; or (C) Has similar national certification for food service management and safety from a national certifying body; or (D) Has an associate's or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; or (E) Has 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023, that includes topics integral to managing dietary operations including, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving Certification from ServSafe, or similar national certification for food service management and safety from a national certifying body, meets the requirement for option C, S483. 60(a)(2(i)(C). Successful completion of the ServSafe food manager program (or other nationally recognized course of study in food safety and management) by Oct. 1 AND two or more years of experience as a director of food and nutrition services in a nursing facility setting, meets the regulatory requirement of the option E, described in S483.60(a)(2(i)(E) '

3.1-20(c)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 26 of 28 155799 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 155799 B. Wing 07/01/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Marion LLC 614 West 14th Street Marion, IN 46953

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)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or 45122 potential for actual harm Based on observation, interview, and record review, the facility failed to implement infection prevention Residents Affected - Few strategies related to enhanced barrier precautions (EBP) for 2 of 4 residents reviewed for transmission-based precautions. (Resident 44 and Resident 53)

Findings include:

1. During an observation, on 6/24/24 at 12:15 p.m., Resident 53 was lying in his bed. The resident's door and room had no posted signage.

During an observation, on 6/25/24 at 2:19 p.m., the resident was lying on his back in bed with his eyes closed. The resident's door had no posted signage.

Resident 53's clinical record was reviewed on 6/26/24 at 2:25 p.m. Diagnoses included methicillin susceptible staphylococcus aureus infection as the cause of diseases classified elsewhere, nontraumatic hematoma of soft tissue, other mechanical complication of surgically created arteriovenous fistula, and dependence on renal dialysis.

The physician orders lacked an order for enhanced barrier precautions.

A progress note, dated 1/19/24 at 1:24 p.m., indicated the resident readmitted to the facility with a wound to

the left lower leg with an attached wound vacuum.

A wound summary, provided by the DON on 6/26/24 at 3:30 p.m., indicated the resident had a surgical wound to the left outer calf. On 1/22/24, the surgical wound measured 14 cm long by 13 cm wide. The wound bed was 60 % bright beefy red tissue, 15% slough, and 25% necrotic tissue. On, 6/18/24, the surgical wound measured 4.0 cm wide by 2.4 cm wide. The wound bed was 100 % bright pink or red tissue.

A wound summary, provided by the DON on 6/26/24 at 3:30 p.m., indicated the resident had an unstageable pressure injury to the right heel. On 1/22/24, the pressure injury measured 3.0 cm long by 4.0 cm wide. The wound bed was 10% pink or red non-granulating (surface smooth and red) tissue, 30% slough (yellow/white dead tissue), and 60% necrotic (nonviable tissue), hard, firmly adherent tissue. On 6/18/24, the pressure injury measured 1.4 cm long by 2.0 cm wide. The wound bed was 100 % pink or red non-granulating tissue.

During an interview, on 6/26/24 at 10:09 a.m., CNA 23 indicated if a person was on EBP it would be on the door and the PPE would be inside the room. If the PPE chest was outside the room, then it was some other type of isolation precautions. She indicated there were two residents on the D Hall that were on precautions.

She did not include Resident 53.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 27 of 28 155799 Department of Health & Human Services Printed: 09/22/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 155799 B. Wing 07/01/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care Marion LLC 614 West 14th Street Marion, IN 46953

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)

F 0880 During a wound observation, on 6/27/24 at 3:28 p.m., LPN 8 washed her hands, applied gloves and proceeded to perform pressure injury wound care and surgical wound care. The pressure injury wound bed Level of Harm - Minimal harm or was beefy red, and quarter sized on the right heel. The surgical wound bed was beefy red on the left lower potential for actual harm leg. LPN 8 did not apply a gown prior to the dressing change. The door and room lacked signage and PPE for EBP. Residents Affected - Few

During an interview, on 6/28/24 at 10:40 a.m., LPN 8 indicated Resident 53 was not on EBP because one of his wounds was surgical.

During an interview, on 6/28/24 at 2:35 p.m., the DON indicated Resident 53 should have been placed on EBP.

During an interview, on 6/28/24 at 5:06 p.m., the DON indicated she had spoken to her corporate infection preventionist about the resident and EBP. The resident's wounds were considered chronic and had existed greater than 28 days. He required EBP.

50721

2. Resident 44's clinical record was reviewed on 6/26/24 at 9:28 a.m. Diagnoses included: other abnormalities of gait and mobility and Type 2 diabetes mellitus without complications.

During an observation on 6/24/24 at 10:20 a.m., Resident 44's door was open and an Enhanced Barrier Precautions (EBP) sign was located on the door. A personal protective equipment (PPE) cart was located outside of her room.

A wound summary, provided by the DON, on 6/26/24 at 3:35 p.m., indicated the resident had an active pressure wound to her coccyx, present on admission. On 6/18/24 at 11:45 a.m., the assessment indicated

the pressure ulcer measured 0.4 cm wide, 0.4 cm long and 0.4 cm deep, 100% bright pink or red with no undermining, no tunneling and no exudate (drainage). On a prior assessment, dated 4/9/24 at 2:49 p.m., the pressure ulcer measured 1.0 cm wide, 0.5 cm long, and 0.5 cm deep.

During a wound observation on 6/27/24 at 3:34 p.m. the ADON performed wound care for Resident 44.

During an interview at the same time, the ADON indicated that she did not wear a gown and should have worn a gown during the dressing change as the resident has an EBP sign on the door and a gown should be worn during pressure ulcer dressing changes.

A current facility policy, revised 5/7/24, provided by the Administrator on 7/1/24 at 4:34 p.m., titled Enhanced Barrier Precautions, indicated the following: .EBP are indicated for residents with any of the following: . Chronic Wounds .Examples of chronic wounds include, but are not limited to: Pressure ulcers, Diabetic foot ulcers, Unhealed surgical wounds, Venous stasis ulcers .For residents for whom EBP are indicated, EBP is employed when performing the following high-contact resident activities .Dressing, Bathing/showering, Transferring, Providing hygiene, Changing linens, Changing briefs or assisting with toileting .Wound care: any chronic skin opening requiring a dressing

3.1-18(b)(2)

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 28 of 28 155799