Shelby Health And Rehabilitation Center

any representative under the contacts in the electronic medical record (EMR) could receive

contact with R120's representatives other than the POA. A review of the care conference notes in the

left blank.On 04/30/2026 at 8:27 AM, the administrator reported they had communicated with the POA who was reported to be at their wits end. On 04/30/2026 at 10:02 AM, Unit Manager (UM) E reviewed the progress noted for R120 and noted some representative complaints about wound care and R120 not eating and if staff were even trying to assist R120. UM E reported they had addressed these concerns with them and acknowledged the staff may be able to do better. On 04/30/2026 at 10:31 AM, Licensed Practical Nurse (LPN) F reported R120's family had asked them about the wound dressings and R120 not eating enough.On 04/30/26 at 2:53 PM, the DON acknowledged the identified concerns and reported there was a new team in place, and they were actively working on improvements in patient care.A review of the record for R120 revealed R120 was admitted into the facility on [DATE].

Diagnoses included Dementia, Heart Disease, and Pressure Ulcer of the Sacral (lower back and tailbone area).The April 2026 Treatment Administration Record (TAR) documented order changes for the heel wounds on 04/05 and 04/16 and the addition of a right lower extremity wound on 04/18. A treatment initiated 04/22 for a skin tear on the top of the left foot.

The Minimum Data Set (MDS) dated , 04/02/26 documented, severe cognitive impairment, the dependence on staff for lower body dressing, toileting, rolling left and right in bed, sitting at the side of the bed and transfer.

Substantial/Maximal assistance was required for upper body dressing.The active care plan initiated 03/27/26 documented, Difficulty Hearing .Impaired Vision .risk for fall . chronic pain . self-care deficit . indwelling urinary catheter . pressure ulcer .encourage and assist to reposition . at nutritional risk .A review of the care plan additions since the original care conferences included: Cognitive risk of Fluctuation initiated, 04/06/26 . resident wishes to return to community home, initiated 04/06/26 . At risk for changes in behavior and mood, initiated 04/06/26 .

Risk for dehydration, initiated 04/07/26 . has anemia, initiated 04/07/26 . has hypothyroidism, initiated 04/07/26 . monitor nutritionally pertinent labs initiated 04/07/26, RD to evaluate and make diet change recommendations, initiated 04/07/26 . risked constipation, initiated 04/07/26 .Actual infection of urinary tract, initiated 04/15/26 . A wound consult note date 04/24/26 noted the three existing wounds to the buttocks had merged into one. A review of the progress notes did not indicate contact to the POA related to changes in the care plan and wounds.A review of the facility policy titled, Change in Condition Notification with reviewed date of 02/02/26, revealed, It is the policy of the facility to notify the resident, his or her attending physician/practitioner, and the resident's designated representative of changes in the resident's medical/mental condition and/or status .

The nurse will notify the resident, the resident's physician/practitioner, and the resident's designated representative when there is: An accident or incident involving the resident which results in an injury and has the potential for requiring physician/practitioner intervention. A significant change in the resident's physical, mental, or psychosocial status, such as deterioration which includes life-threatening conditions or clinical complications. A need to alter the resident's medical treatment significantly such as: A new treatment.

Discontinuation of current treatment due to adverse consequences, an acute condition, or exacerbation of a chronic condition .