Corewell Health Rehab & Nursing Center-commons Far

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

2.5 x 5.0 cm.left posterior lower leg wound measuring 5 x 1.3 cm with pink base with some yellow slough (non-viable yellow, tan, gray, green or brown tissue).A review of a Shower Skin Assessment dated 8/6/25 revealed the following documentation, right and left lower rear leg. Previous skin assessments and progress notes prior to 8/5/25 did not note any impairment to the right or left posterior legs. On 8/14/25 at approximately 2:30 PM, an observation of Resident R803's posterior lower leg wounds were conducted with RN ‘C'.

A small open area, pink in color was observed on the right lower leg and a small open area that appeared slightly deeper with a darker center was observed on the back of Resident R803's left lower leg. On 8/14/25 at 2:38 PM, an interview was conducted with RN ‘C'. When queried about what type of wounds were on the backs of Resident R803's bilateral lower legs and how he developed wounds there, RN ‘C' reported she did not know. RN ‘C' identified the wounds when doing skin assessments of all the residents. RN ‘C' said she was not sure if

they were pressure ulcers or if maybe Resident R803 injured them in the wheelchair. RN ‘C' further reported Resident R803 was evaluated by Physician ‘B' on 8/12/25 and provided the consultation. At that time, a review of a Wound/Vascular Consult done by Physician ‘B' on 8/12/25 revealed documentation that Resident R803 had a Rt (right) leg wound that measured 2.3 cm x 0.3 cm and a Lt leg wound that measured 2.3 cm x 1.5 cm. There was no further description of the wounds included in the assessment.On 8/14/25 at 3:40 PM, an interview was conducted with the DON. When queried about what happened to the backs of Resident R803's lower legs, the DON did not offer a response. When queried about who determined the type of wounds, the DON reported Physician ‘B'. At that time, Physician ‘B's wound consultation for Resident R803 was reviewed with the DON who said

it should be more descriptive. When queried about how further breakdown could be prevented if they were not aware of how Resident R803 got the wounds, the DON reported the facility had problems with wounds and they recently hired RN ‘C' to be the Wound Care Coordinator, as they did not previously have one. A policy regarding Skin Management of Non-Pressure Wounds was requested. However, only a policy regarding Pressure Ulcers was provided.

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/14/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Corewell Health Rehab & Nursing Center-Commons Far

21450 Archwood Circle Farmington Hills, MI 48336

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 0686 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

document.8. Communicate the new area and treatment orders to the Wound Care Nurse.10. The Wound Care Nurse will update the plan of care with the Current stage and location of the wound. RN ‘C' explained that Physician ‘B' came to the facility once a week to evaluate all skin impairments, including pressure ulcers. When queried about Resident R801, RN ‘C' reported she was not the Wound Care Coordinator at that time.

When queried about when the new skin tear to Resident R803's coccyx was assessed, RN ‘C' reported it was evaluated by Physician ‘B' on 7/29/25 and at that time it was a Stage II pressure ulcer. When queried about how the wound first presented upon readmission from the hospital on 7/26/25 and if it should have been assessed when it was identified, RN ‘C' reported it should have so that a treatment could be implemented right away. On 8/14/25 at 3:40 PM, an interview was conducted with the Director of Nursing (DON) regarding Resident R801. When queried about the incident report for Resident R801 dated 6/26/25 that indicated Resident R801 had a skin tear to the buttock and when the skin tear was assessed, the DON said it was assessed at the time of

the incident report. When queried about where the assessment was documented to include the size and appearance of the wound, the DON reviewed Resident R801's clinical record and confirmed there was no documented assessment prior to the note on 6/30/25 and Physician ‘B's consult on 7/1/25. When queried about any assessment of the wound, which was classified as a Stage 3 pressure ulcer on 7/1/25, between 7/1/25 and 7/15/24 when Physician ‘B' next evaluated Resident R801, the DON reported there was no documented assessment. When queried about the Shower Skin Assessments and how none of them document any impairment to Resident R801's skin, the DON reported they only document new skin impairments. When queried about whether they should identify worsening wounds on the skin assessments, the DON reported that would likely be identified by the treatment nurse, not the person doing the skin assessment. When queried about any physician's orders for treatment to Resident R801's coccyx prior to 7/1/25, the DON reviewed the clinical

record and confirmed there was no ordered treatment until 7/1/25. A review of a facility policy titled, Pressure Injury: Assessment, Prevention and Care, dated 4/21/24, revealed, in part, the following: .Skin Assessment.Head to toe visual examination of all skin surfaces and mucous membranes, monitoring temperature, turgor, color, moisture level and skin integrity, paying special attention to all bony prominences. Performed on admission and weekly. Complete documentation of wounds and pressure injuries will be completed by the nurse on a weekly basis. Dressing condition and dressing care must be documented and may include: .Location.Condition of surrounding tissue and wound edges.Tissue base (majority).Exudate(s) type and odor (if present).Vertical length (longest length) - weekly documentation at minimum.Horizontal Width (widest width) - weekly documentation at minimum.Depth (deepest part of wound or injury).Tunneling/Undermining (if present).Wound bed type and color.Pain prior to and after wound care.Condition of dressing must be documented with every skin assessment, including type, intactness, drainage, and surrounding skin.Documentation of pressure injuries will be done at least once a week by the Nursing Supervisor or designee.Plan of Care: the plan of care will be updated with individualized interventions to address identified risk factors and maximize potential to heal any current pressure injuries.

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