Tallmadge Health & Rehab Center

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

the floor, and the G-tube was leaking gastric contents onto Resident #39, his clothes, his incontinence brief, his abdominal binder, the wheelchair and the floor. Nurse #430 stated Resident #39 had a J-tube (jejunostomy tube) that was connected to the tube feeding, and he had a colostomy. Nurse #430 stated Resident #39 scratched himself and caused redness to the abdomen and penis, and there was no treatment ordered for the reddened areas.Interview on 09/25/25 at 1:23 P.M. of Nurse #229 revealed she did not remember caring for Resident #39 on 08/31/25 when his G-tube became dislodged, his ostomy bag was not attached to the ostomy site, and he was transported to the hospital.Interview on 09/25/25 at 5:15 P.M. of Nurse Practitioner (NP) #435 revealed she was not aware Resident #39 had redness of his lower abdomen and penis and was not notified the areas were red. NP #435 stated she was not surprised the areas were red because he had a G-tube and a colostomy. NP #435 stated Resident #39 had a colostomy,

a trach, and a J and G tube. There was one tube inserted into Resident #39's abdomen and it had two ports. The G-tube was for gastric emptying and the J-tube was connected to tube feeding.Review of the facility policy titled Ostomy Care Procedure revised 09/19/24 included nursing personnel with demonstrated competence may provide routine ostomy site care. Changing the ostomy system included to remove and empty the used pouch, remove the wafer by gently and gradually loosening around the adhesive area, and gently cleanse the peristomal area with warm tap water and wash cloth, do not use soap. Pat the stoma and skin dry, and measure the stoma size using the measuring guide. It was important to fit the opening closely to the size of the stoma so little peristomal skin was exposed. Trace the pattern of the size of the opening on the wafer backing and cut the opening to size. Apply skin prep to the peristomal skin, remove adhesive wafer back and apply firmly to the peristomal skin. Attach the new bag to the [NAME] and close

the end of the pouch with the closure device. Document per policy.Review of the facility policy titled Enteral Feeding Tube Policy revised 11/19/24 included licensed clinicians with demonstrated competence may administer enteral feedings and provide tube, site care. At each access of the tube for installation of fluids, nutrition, or medications, verification of placement would be conducted using the following methods: evaluate the clinical presentation of the residents including respiratory status, complaints of nausea, vomiting, feelings of fullness or excessive belching, or unusual abdominal distention. Observation of the volume and character of gastric aspirate. Do not use the tube if there was any doubt about its correct placement and contact the physician, provider for guidance. Enteral tube entrance [NAME] would be monitored daily and observed for erythema, edema, drainage including quantity, odor, appearance. Nurses should monitor the condition of the tube with each use and inform the physician if the tube becomes unusable, leaks or might need replacement. This deficiency represents non-compliance investigated under Complaint Number 2609502, 1404959, 1404954, and 1404958.

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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

10/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Tallmadge Health & Rehab Center

619 Northwest Avenue Tallmadge, OH 44278

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

#400 stated the open areas and dressings were only documented by one aide, and felt the aide could have made a mistake. RDO #400 stated the nurses documented there were no skin issues. Review of the facility policy titled Pressure Injury Prevention and Treatment Policy revised 09/18/23 included residents admitted with existing pressure injuries would receive necessary treatment and services, consistent with professional standards of practice, to promote healing and prevent infection. New pressure injuries would not develop unless the individual's clinical condition demonstrated they were unavoidable. Pressure injuries identified would be assessed initially and at least weekly thereafter, until closed. All assessments would include location and stage, size, exudate, pain, wound bed, appearance of surrounding tissue and any evidence of infection. Pressure injuries identified would be documented and orders obtained from providers for treatment.This deficiency represents non-compliance Complaint Number 2624905, 2609502, 1404959, 1404954, and 1404955.

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