Healthwin Health & Rehabilitation

Review of weekly skin assessments for Resident 67, completed on 1/30/2023, 2/6/2025 and on 2/13/2025 indicated the resident did not have any new skin issues.

A care plan related to skin, dated 7/14/2022, indicated the facility was to complete weekly skin assessments.

On 2/18/2025 at 2:02 P.M., the DON provided a policy titled, Non-Pressure Injury/Ulcer Management, undated, and indicted that the policy was the one currently used by the facility.

The policy indicated .The nursing facility will ensure systems and processes to assist in the identification, investigation, treatment and care of residents with non-pressure injury related to wounds.

Skin wounds affect quality of life for resident's because they may limit activity, may be painful, and may require time-consuming treatments and dressing changes.

Specific Procedures/ Guidance: 2.

Weekly skin observations will be conducted by a licensed nurse and findings will be documented in the resident's medical record. 3.

Observations of new areas of impaired skin integrity will be reported to the physician/practitioner for further evaluation and treatment.

Treatment Protocols: 1.

Treatment will be ordered by the physician/practitioner.

Care Plans: 1. A resident centered care plan will be developed and implemented to address the resident's wound including interventions to promote healing and to minimize worsening or wound or development of additional wounds . 3.1-37(a)

155153 02/19/2025

Healthwin Health & Rehabilitation 20531 Darden Rd South Bend, IN 46637

During an interview on 2/17/2025 at 2:10 P.M., Resident K indicated she had to wait this past Sunday to use the toilet.

She indicated her back hurts when she had to hold it for too long.

She indicated she had hardly seen the CNA working.

She indicated she had ended up wetting the bed, which made her feel terrible.

She had to ask her husband to help her with the bed pan because no staff had answered her call light.

She indicated her husband had tried to help her but when he took her off the bedpan, it had spilled onto the bed and soiled the linens.

During an interview on 2/17/2025 at 2:21 P.M., Resident L indicated his care this past weekend was non-existent. He indicated it was like that every weekend. He indicated he had gone without fresh ice water all weekend, even though he had asked for it but no one had answered his call.

When the aide had arrived, the resident was informed the aide was the only one working and so the resident was unable to get out of bed, be washed up or dressed. He laid in his bed, in a gown, all weekend.

Resident L indicated he had really wanted to get up on Sunday because he needed to have a BM. He indicated he had tried to hold it, for over an hour but when help had finally arrived, he had an explosion in his brief and on the floor. He indicated he was so embarrassed about the accident.

During a interview on 2/17/2025 at 7:21 P.M., Resident C indicated that she had been at the facility for 5 weeks and had only received one shower.

She indicated she was never offered a shower by the staff.

On 2/13/2025 at 9:00 A.M., a policy was requested for staffing and the DON provided a policy titled, Nursing Staffing Information Policy, undated and indicated the policy was the one currently used in the facility.

The policy indicated .The facility will post nursing staffing information daily in a prominent place readily assessable to residents and visitors .

There was no specific information in the policy regarding actual staffing requirements or adjustments to be made based on resident acuity levels. 3.1-17(a)(b)

155153 02/19/2025

Healthwin Health & Rehabilitation 20531 Darden Rd South Bend, IN 46637

During an interview with LPN19 on 2/18/2025 at 11:44 A.M., he indicated if Resident 71 had a blood pressure reading under 110, the facility nurses should have administered midodrine.

During an interview with the DON on 2/18/2015, at 12:00 P.M., she indicated staff should have administered midodrine when the resident's systolic blood pressure reading was below 110.

A policy for pharmacy services was requested but one was not received before the exit of the survey.

This Federal tag relates to Complaint IN00451914, IN00451952, IN00452177, IN00451978, and IN00451284. 3.1-25(a) 3.1-25(b)

During a Family meeting with the new corporate representatives and the Director of Nursing, conducted on 2/12/2024 at 2 PM, several resident representatives complained about the lack of staffing to provide care, especially at night and residents not receiving timely showers or medications.

The family representatives queried the new corporate staff and DON about reducing the number of staff and firing the QMAs (Qualified Medication Aides) and shower aides.

The Director of Nursing informed the family members that the staff were not fired but were just not given as many work hours.

The corporate representative informed the family members that the facility was staffed at a 3.5 PPD (hours of direct nursing care per resident per day) which was above the national average.

The meeting ended abruptly when family members became emotional and loud after being told individual concerns would not be directly addressed during the meeting.

During an interview on 2/17/2025 at 11:18 A.M., the DON indicated the facility determined the staffing levels needed to meet each residents' needs each day based on acuity.

The DON indicated in addition, during emergencies they used nursing staffing agencies and staff were allowed to pick up hours through their messaging service.

She indicated the facility was staffed with a nursing supervisors every shift, 7 days a week.

She indicated she had not received any staffing concerns from the families or residents until the newscasters had came to the facility.

She did concede the nursing staff had voiced their concerns and the facility was trying to adjust to the new corporations staffing patterns.

Review of the Facility Assessment, provided on 2/17/2025 at 10:30 A.M. by the DON, regarding nursing staffing needs, dated 1/16/2025, indicated the following staffing needs: RN 14.8 (hours scheduled per day) LPN 18.6 (hours scheduled per day), CNA 63.5 per day (hours scheduled per day).

Using this ratio for a census of 107 residents, the required, facility assessed PPD would be 6.79.

However, after a discussion with the DON, on 2/17/2025 at 1:38 P.M., a corrected facility assessment was provided which indicated the following nursing staff requirements: RN 5.38 (hours per day), LPN 12.55 (hours scheduled per day) and CNA 26.88 (hours scheduled per patient per day).

This ratio, utilizing the current facility census of 98 residents equaled 3.42 PPD of nursing staff. It was unclear if any adjustments had been made to the PPD requirements due to resident acuity.

155153

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 155153 B.

Wing 02/19/2025

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

Healthwin Health & Rehabilitation 20531 Darden Rd South Bend, IN 46637