Parkwood Skilled Nursing And Rehabilitation Center

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

9/17/25 at 10:40 P.M., the resident has a dark, soft area to resident's right heel; The area was assessed and is not open at this time.-On 10/11/25 at 3:49 A.M., the dark soft area to the resident' s right heel has opened. Slough (yellowish, soft, and often stringy material that forms in wounds as a result of dead or dying tissue) noted to wound bed and eschar (dark colored dead tissue) noted. The area is measuring 3 centimeters (cm) length by 7 cm wide;-No documentation the resident's responsible party was notified regarding the resident's right heel pressure wound. Review of the resident's Physician Order Sheets, dated 9/15 through 10/24/25, showed:-An order, dated 9/24/25, doxepin (medication used to treat depression) 25 milligrams (mgs) one capsule at bedtime for depression;-An order, dated, 10/6/25 stop date 10/13/25, Depakote Sprinkles (mood stabilizer)125 mg delayed release, two capsule, three times a day for mood disorder due to unknown physiological condition with depressive features;-An order, dated 10/13/25, hydroxyzine (medication used to treat anxiety) 25 mg, one tablet twice a day, for restlessness and agitation.

Review of the resident's Psychiatry Nurse Practitioner (NP) notes, dated 10/4/25, showed: The resident is at the facility for a psychiatric evaluation. The resident does not know where he/she lived. As far as historical information the resident has dementia and cannot provide information. The resident has been very irritable in the evenings, unable to sleep and hard to re-direct. The resident is confused and usually is not congruent (agreement) about what the conversation is about. Medications orders attached to encounter: Depakote Sprinkles125 mg delayed release, two capsules, three times a day; doxepin 25 mgs one capsule at bedtime; hydroxyzine 25 mg, one tablet twice a day. No documentation that the Psychiatry NP notified the resident's responsible party regarding the addition of Depakote Sprinkles, doxepin, and hydroxyzine medications was noted. Review of the resident's progress notes, showed no documentation of staff notifying the resident's responsible party regarding the addition of Depakote Sprinkles, doxepin and hydroxyzine medications. During an interview on 11/5/25 at approximately 12:00 P.M., Licensed Practical Nurse (LPN) C said the resident was confused since the day he/she arrived at the facility. The resident would yell out a lot, disrupt other residents in the common area, and he/she was paranoid. The responsible party, which is usually the family, should be notified of any new wounds, treatments and medications by the Charge Nurse, Nurse Manager or Wound Nurse. Communication with the resident's responsible party is documented in the progress notes. During an interview on 11/6/25 at 8:00 A.M., LPN B said the responsible party should be notified with any medication changes, the development of a pressure wound and if the condition of the wound changes. LPN B wasn't sure if the Charge Nurse or the Psychiatry NP notifies the resident's responsible party when new medication is ordered. The Charge Nurse or the Wound Nurse notifies the resident's responsible party regarding skin conditions. During an interview on 11/6/25 at 9:32 A.M., Nurse Manger A said the Psychiatry NP will add his/her own orders into the computer without notifying nursing staff that the new medication is added. The Psychiatry NP notes, dated 10/4/25, were the only notes that were e-mailed to Nurse Manager A. The resident was confused, and the responsible party should have been notified regarding the condition of the pressure wound and the new medications. During

an interview on 11/6/25 at 12:30 P.M., the facility's Wound Nurse said the Charge Nurse or the Wound Nurse are responsible for notifying the resident's responsible party when a wound is identified or there are changes in the wound. During an interview on 11/6/25 at 10:45 A.M., the Director of Nursing said the resident's responsible party is expected to be notified by the nursing staff of any changes in condition, changes in a wound, and new medication or treatment orders. She expected the notification to be documented in the progress notes. 2655121

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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

11/06/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Parkwood Skilled Nursing and Rehabilitation Center

3201 Parkwood Lane Maryland Heights, MO 63043

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

dead tissue) applied to wound bed and covered with silver alginate (a specialized dressing) and secured with a foam dressing. The treatment is to be completed daily and as needed. Review of the medical record, showed no further completed skin assessment data forms and no further documentation of the condition of

the resident's right heel pressure wound was noted. During an interview on 11/6/25 at 8:00 A.M., LPN B said on admission, a head-to-toe assessment should be completed. The weekly skin assessments are signed off on the TAR and a skin assessment data form should be completed even if there are no skin issues to report. If the resident has wounds or a skin condition, a description and the condition of the wound should be addressed on the weekly skin data assessment and in the progress notes. If a change in condition occurs related to the wound, the facility Wound Nurse is called. The Wound Nurse completes some of the treatments but not all of them. During an interview on 11/6/25 at 9:32 A.M., Nurse Manger A said the admission for the resident was not completed. The resident did not have a Braden Score completed or a skin assessment on admission. A head-to-toe assessment is expected to be completed on admission and weekly. The Charge Nurse is expected to sign off the TAR, complete a skin data form, and write a note related to wound's condition if applicable every week. During an interview on 11/6/25 at 12:30 P.M., the Wound Nurse said the Charge Nurse is responsible for documenting the weekly wound assessments and completing treatments. A head-to-toe assessment is to be completed and documented

on admission by the admitting nurse. The Wound Nurse said she was not sure if the resident came into the facility with the right heel pressure wound because a skin assessment was not performed on admission.

She was not aware of the dark, soft area to the resident's right heel until 9/17/25 when a staff member notified her. The Wound Nurse said the soft dark area to the resident's right heel was a deep tissue injury (damage to the skin underneath and appears like a dark bruise) when she initially assessed the wound.

She was notified on 10/11/25 by a staff member that the resident's right heel had opened and at that time,

she consulted the Wound Nurse Practitioner. The Wound Nurse is not responsible to document the condition of the wound weekly unless the resident is seen by the Wound Nurse Practitioner. The resident was not seen by the Wound Nurse Practitioner until 10/16/25. The Wound Nurse said she does not complete all the treatments, and if the wound is not looking better, she expected staff to inform her. The resident's skin assessment completed on 10/6/25 is inaccurate. She expected staff to accurately describe

the resident's skin condition and where the skin condition is located. She expected staff to sign the treatment off on the TAR and complete a skin data assessment form each week. The Wound Nurse said

she also has Nurse Manager duties, and it would be impossible for her to complete every skin assessment

on every resident every week. During an interview on 11/6/25 at 10:45 A.M., the Director of Nursing said

she expected weekly skin assessments to be completed timely and accurately. If a resident has a wound,

she expected staff to add a progress note about the progression or decline of the wound each week.

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