Wausau Manor Health Services

F 0583

Keep residents' personal and medical records private and confidential.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observations, record review, and interviews, the facility failed to provide privacy during wound care for one of three residents (R) 3, reviewed for wound care out of a total sample of 6 residents. This failure had the potential for Resident R3 to experience embarrassment or feeling exposed during treatment. Findings include:

Review of Resident R3's undated Face Sheet located under the Profile tab in the electronic medical record (EMR) indicated Resident R3 was admitted to the facility on [DATE REDACTED]. Review of Resident R3's admission Evaluation - V3, located under the Assessments tab in the EMR and dated 08/14/25 at 6:44 PM, indicated Resident R3 was alert and oriented to person, place, time, and situation. Review of Resident R3's Physician Orders, located under the Orders tab in the EMR, indicated an order dated 08/19/25 for Left Buttock wound, Sacral redness, and Bilateral Buttock redness: Cleanse with NS [Normal Saline], pat dry, and apply Periguard Ointment every day and evening shift for wound healing and as needed for wound healing. During the wound care observation on 08/21/25 at 11:22 AM, Resident R3 stood using a walker for wound care to be provided to Resident R3's buttocks and sacral area. Resident R3 unbuttoned his pants and underwear and lowered both articles of clothing to mid-thigh level. Resident R3's blinds, covering the window, were left open while the wound care was being performed by Registered Nurse (RN) 1. RN1 did not ask Resident R3 if he wanted the blinds to be shut prior to the start of the wound care.

Anyone that would walk by the window would be able to see that Resident R3 was having wound care performed to his buttocks. During an interview on 08/21/25 at 11:35 AM, RN1 confirmed she should have closed the blinds before performing wound care to Resident R3's sacral area. During an interview on 08/21/25 at 11:37 AM, Resident R3 was asked about the window blinds that were left open during wound care. Resident R3 stated, Sure, it would bother me if someone saw me. I would prefer them [staff] to close the blinds. During an interview on 08/21/25 at 2:00 PM, the Interim Director of Nursing (IDON) stated, I expect the nurses to provide dignity and respect when performing wound care to a resident by closing the blinds prior to wound care.

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wausau Manor Health Services

3107 Westhill Dr Wausau, WI 54401

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

healing and as needed for wound healing. During the wound care observation on 08/21/25 at 11:22 AM, Registered Nurse (RN) 1 placed a barrier on the overbed table without cleaning it first. RN1 then proceeded to clean the left buttock wound, bilateral buttocks, and sacral areas with NS. RN1 patted these areas dry with a 4x4. RN1 applied Periguard Ointment to these areas using a tongue blade. RN1 wore gloves but did not wear a gown while performing this wound care. During an interview on 08/21/25 at 1:35 PM, RN1 stated, I didn't wear a gown because [Resident R3] wasn't in Enhanced Barrier Precautions. When asked if Resident R3 should be in EBP, RN1 stated, Yes, because [Resident R3] has an open wound. When asked if a tongue blade should have used to apply the ointment to Resident R3's buttocks RN1 stated, That's what I was told to apply it with. During

an interview on 08/21/25 at 11:50 AM, the Infection Preventionist (IP) stated, I expect them [nurses] to clean off the bedside table and then place a barrier down to place the clean supplies on. The nurse should change her gloves after cleaning the wound, sanitize or wash her hands then place a clean pair of gloves

on before applying skin prep around the wound. A tongue blade should not be used to apply ointment to a resident. When asked if Resident R3 should be in Enhanced Barrier Precautions [EBP], the IP stated, According to

the new guidance, a wound that will take more than a few days to heal, that resident should be placed in EBP and the nurse [should] apply the appropriate PPE when caring for the resident. Notified IP that Resident R3 was not in EBP at this time. During an interview on 08/21/25 at 2:00 PM, the Interim Director of Nursing (IDON) stated, . The nurse should establish a clean barrier and clean it with a sanitizing wipe before placing a barrier down and then the clean supplies. Applying the skin prep is not part of the cleaning process but rather a part of dressing a cleaned wound. The nurse should clean the wound as ordered by the physician, then remove the dirty gloves, wash or sanitize her hands and then apply a clean pair of gloves before applying the skin prep around the wound. Asked how a nurse should apply ointment to the buttocks of a resident and the IDON stated, They should use a clean applicator such as a Q tip. Asked if a tongue blade could be used to apply the ointment and the IDON stated, No, it shouldn't. That could have sharp edges or splintering from the wood used and cut the wound more and that is not what you want to do, You want to protect the skin that you are applying the ointment to. Asked if a nurse was dressing a wound such as for Resident R3, the resident should be in Enhanced Barrier Precautions. The IDON stated, Yes, they should be in EBP [Enhanced Barrier Precautions]. Notified the IDON that Resident R3 was not in Enhanced barrier Precautions and

the nurse performing wound care only wore gloves. The IDON confirmed the nurse should have also worn a gown.

Event ID:

Facility ID:

If continuation sheet