**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, medical record review, hospital record review, and interview, the facility failed to ensure residents received the necessary treatment and services consistent with professional standards of practice to promote healing, prevent infection and prevent new ulcers from developing, failed to initiate wound treatments when a wound was identified on admission, failed to complete skin assessments on residents, and failed to administer wound treatments for residents determined to be at risk of skin breakdown for 3 of 4 (Resident #8, #70 and #80) sampled residents reviewed for pressure ulcer wounds. Resident #80 was admitted to the facility on [DATE], with a Pressure Ulcer/Injury to the sacrum. No treatments were ordered at that time. Treatments were administered 8 days after admission. The Pressure Ulcer/Injury deteriorated to a Stage 3 and on 2/22/2025, Resident #80 was transferred to the hospital for an infected wound. Resident #70 was admitted to the facility from the hospital on 7/14/2025 and hospital records documented his skin was intact. Nine (9) days after admission to the facility, a skin sweep identified a Stage 3 Pressure Ulcer/Injury on Resident #70's Right Buttock. The facility's failure resulted in Immediate Jeopardy (IJ) for Resident #80 and #70. The facility failed to ensure wound treatments were provided daily as ordered for Resident #8. Immediate Jeopardy is a situation in which the provider's noncompliance with one or more requirements of participation has caused or is likely to cause serious injury, harm, impairment, or death of a resident. The Administrator and the Director of Nursing (DON) were notified of the Immediate Jeopardy (IJ) for F-686 on 8/7/2025 at 5:27 PM, in the Sunroom. The facility was cited Immediate Jeopardy at F-686. The facility was cited Immediate Jeopardy F-686 at a scope and severity of J which is Substandard Quality of Care. The Immediate Jeopardy began on 2/6/2025 through 8/11/2025, the IJ was removed on 8/12/2025. An acceptable Removal Plan, which removed the immediacy of the Jeopardy, was received on 8/11/2025 at 11:25 AM, and the Removal Plan was validated onsite by the surveyors on 8/11/2025 and 8/12/2025 through policy review, medical record review, review of education records, and staff interviews. The facility's non-compliance at F-686 continues at a scope and severity of D for monitoring the effectiveness of the corrective actions. The facility is required to submit a Plan of Correction. The findings include: 1. Review of the facility policy titled, Charting and Documentation, dated July 2017, revealed .The following information is to be documented in the resident medical record .Medications administered .Treatments or services performed .the date and time the procedure/treatment was provided . Review of the facility policy titled, Prevention of Pressure Injuries, dated April 2020, revealed .Risk Assessment.Assess the resident on admission for existing pressure injury risk factors. Repeat the risk assessment weekly and upon any changes in condition.Conduct a comprehensive skin assessment upon (or soon after) admission with each risk assessment.Inspect the skin on a daily basis. 2. Review of the medical record revealed Resident #80 was admitted to the facility on [DATE], with diagnoses including Metabolic Encephalopathy, Pneumonia, Malnutrition, Depression, Stage 5 Chronic Kidney Disease and Pressure Ulcer Stage 3. Review of the admission care plan for Resident #80 dated 2/6/2025, revealed .SKIN INTEGRITY .PROBLEM Wound care (see tx [treatment] orders) . Review of the INITIAL SKIN INJURY DOCUMENTATION for Resident #80 dated 2/6/2025, revealed .on admission.Sacrum.Length 10 CM [centimeter] Width.9 CM.Depth 0.1 CM. Review of the Wound Assessment for Resident #80 revealed, .Date of Assessment 02/8/2025.Present on admission.Sacrum .Pressure .Stage 2 .Odor.No.Length.10.50 [cm].Width.9.00 [cm].Depth.0.1 [cm]. Review of the Inpatient Physicians [Named Group Practice] form dated 2/8/2025, revealed .sacral P.U. [pressure ulcer also known as pressure wound] stage 3 / 4. Review of the 5 day Minimum Data Set (MDS) assessment dated [DATE], revealed a Bried Interview for Mental Status (BIMS) score of 15 which indicated Resident #80 was cognitively intact. Resident #80 was dependent on staff for all Activities of Daily Living (ADLs), always incontinent of bowel and bladder, and had a stage 2 pressure ulcer on admission. Review of the Physician's Orders for Resident #80 dated 2/12/2025, revealed .Begin Date 02/12/2025 .hydrocolloid [dressing to promote healing of wounds] 3 Times Weekly .SACRUM .Clean area with Normal Saline. Apply Hydrocolloid for autolytic debridement . Review of the February Treatment Administration Record (TAR) for Resident #80 revealed wound care to the sacrum was not ordered until 2/12/2025.hydrocolloid.Three Times weekly Starting 02/12/2025 . Review of the February TAR revealed no documentation wound care treatments were performed on the Resident's sacrum would until 2/14/2025, when the sacrum wound had declined to a Stage 3. Review of the Wound Assessment for Resident #80 dated 2/17/2025, revealed .Odor.No.Length.11.50 [cm].Width.10.00 [cm].Depth.< [less than] 0.2 [cm].Wound was previous [previously] classified on [as] stage 2 on admission has now declined and is now classified as a stage III [3]. Resident place on alternating pressure mattress. Review of the care plan dated 2/18/2025, revealed, .Problem.has stage 2 pressure injury, POA [present on admission] . now stage 3 . Review of the progress notes dated 2/22/2025, revealed .2/22/2025 Resident's daughter in building requesting that resident be transferred to [Named Hospital] ER [emergency room].possible infected wound that is worsening with foul odor. Order carried out at this time. Spoke with weekend on call NP [Nurse Practitioner]. Review of Hospital #1's emergency room records for Resident #80 dated 2/22/2025, revealed .Chief Complaint .Wound Check .with c/o [complaint] unstageable sacral wound. Pt [patient] states the wound started .2 weeks ago Aox4 [alert and oriented to person, place, time and situation] .cannot ambulate .Visit Diagnoses .Infected decubitus ulcer .Wound of sacral region .[elderly patient] .presenting to the emergency room from the nursing home with worsening sacral wound with drainage .over the last couple of weeks she has developed ulceration .the drainage and symptoms got worse so they sent her to the ER today .IMPRESSION .Sacral decubitus ulcer with foci of gas extending from the ulcer to the bone [The presence of gas extending from the pressure ulcer to the bone is a serious finding in which can indicate a severe infection] though the ulcer itself does not extend quite as deep .Medical Decision Making .in the emergency room, she had a white count [white blood cell count (WBC) which indicates infection] that was elevated 19,000 [normal WBC range is 4,000-11,000] .she [Resident #80] was started on .antibiotics .we will go ahead and admit, I also consulted general surgery for possible wound debridement . Review of the facility Clinical Notes Report for Resident #80 dated 2/23/2025, the day after the Resident had been discharged from the facility to the hospital, revealed .Wound to sacrum has worsen [worsened], wound bed is dark in color with slough present, surrounding skin tissue has erythema present no odor noted. Wound present now as a stage III. Rp [responsible party] Daughter was present at this time and made aware of mother [mother's] condition and acknowledge understanding of wound care treatment going forward. N.O [New Order] Cleanse with [brand name of wound cleaning solution] .apply [prescription brand name of ointment used to remove dead tissue from wounds to help them heal] followed by Calcium alginate [used for wounds] and cover with Superabsorbent [dressing] daily. MD [Medical Doctor] aware. On 2/25/2025, Resident #80 was transferred from Hospital #1 to Hospital #2 and admitted to inpatient care for worsening/infected sacral wound and for surgical interventions. Review of Hospital #2's Clinical Records for Resident #80 dated 2/26/2025, revealed .REASON FOR VISIT: Infected sacral wound.admitted to [Hospital #1] .2/22 [2025] of worsening sacral wound with foul-smelling drainage.transfer to [Named hospital #2] .2/25 [2025].IMPRESSION.infected sacral decubitus ulcer. Colonized [presence of bacteria] with Pseudomonas aeruginosa[a bacteria that often contributes to delayed healing and increased tissue damage] Needs aggressive wound care and surgical evaluation for possible debridement [a procedure to remove dead, or infected tissue from a wound] of sacral wound (planned for 2/28 [2025] .). Antibiotics will not cure this wound.WOUNDCX [wound culture] 3 + [plus] Pseudomonas aeruginosa 02/24/2025.WBC 20.86 02/23/2025. Review of Hospital #2's discharge document revealed, .Taken to OR [operating room].for infected sacral wound debridement on 2/28 [2025]. Wound growing Pseudomonas. Resident #80 was discharged to another long-term care facility on 3/7/2025. During a telephone interview on 8/6/2025 at 8:53 AM, Wound Nurse J confirmed that Resident #80 was admitted with a stage 2 sacral pressure wound that deteriorated to a stage 3 pressure wound. Wound Nurse J was asked when should wound care be ordered. Wound Nurse J stated, Immediately.I call it [pressure wound] what it is and document and discuss with the doctor or NP . Wound Nurse J was informed that Resident #80's wound care was not ordered until 2/12/2025 and not performed until 2/14/2025. Wound Nurse J stated, .the nurses at that time should have initiated wound care . During an interview on 8/6/2025 at 11:49 AM, the Director of Nursing (DON) confirmed wound treatments should have been ordered immediately and that Resident #80 should have received wound care to the sacrum on 2/6/2025. The DON confirmed the sacral wound went from a stage 2 to a stage 3 pressure ulcer. The DON was asked what should have been done for Resident #80. The DON stated, .should have done a lot of things.if they [referring to the nurses] identify something .should have notified the doctor.it's the protocol.that's what should have happened.if you don't catch it, it's on us.don't know what happened . During an interview on 8/6/2025 at 12:17 PM, Licensed Practical Nurse (LPN) C confirmed she had done Resident #80's initial sacral wound assessment on admission on [DATE]. LPN C stated, .once we identified the wounds.we turn it over to the wound care nurse and they come behind us and identify the treatment plan.we have been told to go ahead and open up skin assessment.identify area.measurement.good description of the wound.if drainage.or odor.do not sign or lock the assessment. LPN C could not recall if she had notified the provider on 2/6/2025 and did not see any documentation that she had notified the provider or provided treatment to the sacral wound. LPN C stated, .we should have had a treatment in place. LPN C reviewed Resident #80's TAR and identified the first treatment was ordered on 2/12/2025 but was not administered until 2/14/2025. LPN C was asked what do you think happened. LPN C stated, It's got to be poor communication, why it took so long. During a telephone interview on 8/6/2025 at 1:15 PM, the Medical Director confirmed he saw Resident #80's sacral pressure wound on 2/8/2025 and stated, .documented as stage 3 or stage 4.large and deep.no draining.or infection.real sick lady.discussed with the wound care when I finished to make sure standard treatment.not for sure what they did.to make sure she received treatment. The Medical Director was asked should Resident #80 have received wound care treatment when the wound was identified. The Medical Director stated, .absolutely.she should have received regular wound care.I'm surprised she didn't. During an interview on 8/6/2025 at 1:45 PM, the Assistant Director of Nursing (ADON) was asked when a wound is identified when should a treatment be started. The ADON stated, .on that day.our policy is the admission nurse.should put something in place. The ADON confirmed wound care for Resident #80 was ordered on 2/12/2025 and wasn't provided until 2/14/2025. The ADON denied that she saw Resident #80's wound. The ADON stated,.I think it was a DTI [deep tissue injury] and it broke down like it should have.I think some incorrect documentation as far as describing the wound.I think the failure was it was a very hard weekend. He [referring to Wound Nurse J] came in and assessed the wound on Saturday.and no charting was done.there was so much going on.I think he just didn't have time to put the order in.he worked the med [medication] cart on Friday.Saturday and Sunday.that weekend we had 2 nurses in the hospital. The ADON confirmed that the wound care nurse, the risk manager, and herself had worked that weekend on the floor. During a telephone interview on 8/6/2025 at 3:38 PM, the Nurse Practitioner (NP) was informed Resident #80 was admitted with a pressure wound on 2/6/2025, and there was no order for wound treatment until 2/12/2025. The NP stated, .we should always have an order, should be standard to have a treatment to start .I'm surprised it wasn't . During an interview on 8/8/2025 at 11:30 AM, the Administrator was asked about the system failure for pressure ulcer identification, initiating treatments, and assessments. The Administrator stated, I think we were focused on the data and not looking deeper on the documentation side of it and really just started focusing on the documentation side of it in July.we are needing to do education.we lost one treatment nurse.and started working with the new one.with her coming on board in June.really July, we could really [have] started working on the process.documentation.complete assessment. 3. Review of the [Named Hospital] Hospital Medicine Progress Note, for Resident #70 dated 7/13/2025, revealed .Skin: No rash or ulcerations . Review of the medical record revealed Resident #70 was admitted to the facility on [DATE], with diagnoses including Metabolic Encephalopathy, Congestive Heart Failure and Hypokalemia. Review of the admission NURSING ASSESSMENT . for Resident #70 dated 7/14/2025 and signed as completed on 8/13/2025, revealed .Skin breakdown/issues noted, Please Refer to Skin Assessment .He is incontinent of B/BL [bowel and bladder]. open area noted to rt [right] buttock . Review of the admission MDS assessment dated [DATE], revealed Resident #70 was severely cognitively impaired. Resident #70 was dependent on staff for bathing, required maximum assistance of staff for mobility, and was always incontinent of bowel and bladder. No skin issues were indicated, but Resident #70 was at risk for pressure ulcers. Review of the care plan for Resident #70 revealed .developed stage 3 pressure injury to right buttock.Date Initiated: 07/23/2025.Administer treatment as ordered and monitor for effectiveness. Date Initiated: 07/23/2025.Assess for any skin breakdown during ADL's Date Initiated: 07/24/2025.Assess/record/monitor wound healing. Measure length, width and depth when possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD [medical doctor]. Date Initiated: 07/23/2025.Monitor/document/report to MD PRN [as needed] changes in skin status: appearance, color, wound healing, s/sx [signs and symptoms] of infection, wound size, stage. Date Initiated: 07/24/2025.Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 07/24/2025.Resident is at risk for skin breakdown/further skin breakdown due to: Decreased mobility/immobility Date Initiated: 07/24/2025.Skin check during ADL care and report significant findings Date Initiated: 07/24/2025.Treatment/med as ordered Date Initiated: 07/24/2025. Review of the SKIN ASSESSMENT (PRESSURE INJURY) . for Resident #70 dated 7/23/2025, revealed Acquired during stay .date of onset 7/23/2025 .Pressure Ulcer Stage .III [3] .Right buttock .Pressure .1.5 [cm-length] .1.2 [cm-width] .0.1 [cm-Depth] .RIGHT BUTTOCK STAGE 3: WOUND BED 100% [percent] GRANULATION [new tissue that forms during the healing process] TISSUE. WOUND EDGES ARE FLAT AND INTACT. PERIWOUND OF NORMAL COLOR. NO ODOR, EDEMA NOR REDNESS NOTED. SMALL AMOUNT OF DRAINAGE NOTED. WOUND BED IS MOIST. NEW ORDER: CLEANSE WITH NS [normal saline], PAT DRY, APPLY XEROFORM [wound dressing that promotes a moist healing] TO WOUND BED AND COVER SILICONE BORDERED FOAM [dressing to promote healing] EVERY MON [Monday], WED [Wednesday], FRI [Friday] AND PRN [as needed]. TOLERATED TREATMENT WELL. NO S/SX INFECTION NOTED . Review of the Physician's Orders for Resident #70 dated 7/25/2025, revealed .RIGHT BUTTOCK STAGE 3: CLEANSE WITH NS, PAT DRY, APPLY XEROFORM TO WOUND BED, COVER WITH BORDERED GAUZE DAILY every day shift for STAGE 3 AND as needed . Review of the TAR for Resident #70 dated July 2025, revealed .RIGHT BUTTOCK STAGE 3: CLEANSE WITH NS, PAT DRY, APPLY XEROFORM TO WOUND BED, COVER WITH BORDERED GAUZE DAILY. every day shift for STAGE 3 -Start Date 07/26/2025 0600 . Resident #70 developed a facility acquired stage 3 pressure ulcer/injury on 7/23/2025. Treatments were not ordered until 7/25/2025 and were not started until 7/26/2025, 3 days after the wound was identified. 4. Review of the medical record revealed Resident #8 was admitted to the facility on [DATE], with diagnoses including Pressure Ulcer Right Hip, Chronic Pain Syndrome and Anxiety. Review of the admission MDS assessment dated [DATE], revealed a BIMS score of 11 which indicated Resident #8 was moderately cognitively impaired. Resident #8 was admitted with an unstageable pressure ulcer. Review of the Care Plan for Resident #8 dated 7/2/2025, revealed, .has pressure injuries.Interventions. Administer treatment as ordered and monitor for effectiveness. Review of the admission NURSING ASSESSMENT. for Resident #8 dated 7/2/2025, revealed . SKIN CONDTION.Skin breakdown/issues noted, Please refer to Skin Assessment. Review of the SKIN ASSESSMENT (PRESSURE INJURY). dated 7/2/2025, revealed .RIGHT UPPER BUTTOCK Pressure.Length 2.1 [cm] Width 2.5 [cm].Depth UTD [unable to determine].Stage Unstageable. Review of the Physician's Orders for Resident #8 dated 7/4/2025 revealed, .Santyl [an ointment that removes dead tissue from the wound so they can start to heal] External Ointment 250 UNIT/GM [gram] Apply to RIGHT UPPER BUTTOCK .everyday shift for UNSTAGEABLE PRESSURE ULCER APPLY NICKEL THICK TOPICALLY TO WOUND BED . Review of the SKIN ASSESSMENT (PRESSURE INJURY). for Resident #8 dated 7/8/2025, revealed, .RIGHT UPPER BUTTOCK Pressure.Length 2.1 [cm] Width 2.4 [cm].Depth UTD.Stage Unstageable.RIGHT UPPER BUTTOCK UNSTAGEABLE PRESSURE ULCER . Review of the SKIN ASSESSMENT (PRESSURE INJURY), dated 7/15/2025, revealed .RIGHT UPPER BUTTOCK Pressure.Length 2.2 Width 2.0.Depth UTD.Stage Unstageable.RIGHT UPPER BUTTOCK UNSTAGEABLE PRESSURE ULCER . Review of the SKIN ASSESSMENT (PRESSURE INJURY), dated 7/22/2025, revealed .RIGHT UPPER BUTTOCK Pressure.Length 3.4 [cm] Width 2.2 [cm].Depth UTM [UTD].Stage Unstageable.RIGHT UPPER BUTTOCK UNSTAGEABLE PRESSURE ULCER . Review of the TAR dated July 2025, for Resident #8 revealed missed wound care to the right upper buttock on 7/7/2025, 7/12/2025, 7/13/2025, and 7/17/2025. During an interview on 8/7/2025 at 9:24 AM, the Administrator stated, .The skin sweep identified an area on [named Resident #8] .The initial admitting [Registered Nurse (RN) E] nurse on 7/14/2025, did not put in the admission assessment in a timely manner and upon review and speaking to her .She [RN E] came in on 8/3/2025 and completed the admission assessment . During an interview on 8/07/2025 at 10:46 AM, RN E stated .I started on the admission .I was going to finish the admission, but I was too tired and went home .I misplaced my cheat sheet, I knew the only thing was his knee abrasions, but when I looked at the chart I saw the wound nurse had charted a pressure ulcer and I doubted myself and thought I missed something .I was late on getting back to complete the admission . During an interview on 8/12/2025 at 12:25 PM, the Administrator was asked should wound care be provided as ordered by the physician. The Administrator stated, Yes ma'am. The Administrator was shown Resident #8's July's TAR and was asked should there be blanks on the TAR. The Administrator stated, Should not be. Review of the facility's removal plan received on 8/11/2025, and verified through record review, observation, and interviews with staff and administration on 8/11/2025-8/12/2025, revealed the following: The facility will ensure vulnerable residents who are at risk for skin breakdown, will receive the necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing. 1) What corrective actions will be accomplished for those residents found to have been affected by the deficient practice. Resident #70: On 7/30/2025 the Treatment Nurse resolved the facility acquired stage 3 pressure injury and this was documented on the skin assessment. On 8/7/2025 the ADON and Charge Nurse completed a full head to toe assessment and no new areas were identified. Resident #80: On 8/8/25 the Administrator verified that the resident was discharged from the facility on 2/22/25. On 8/7/25 the Quality Service Team reviewed the Prevention of Pressure Injuries Policy and the Pressure Injuries Overview Policy and no changes were made. The Administrator and Nurse Managers to include the Director of Nursing, Assistant Director of Nursing, the MDS Coordinators, Risk Manager, and Treatment Nurse were educated on 8/7/25 by the Quality Service Team with post test to ensure competency on the Prevention of Pressure Injuries Policy and the Pressure Injuries Overview Policy. Point Click Care (PCC) process to include identifying and assessing skin injuries/issues through head to toe body audits upon admission using the admission assessment, weekly using the weekly summary assessment, and/or skilled residents using the Alert charting . If skin injuries/issues are identified, same day documentation and communication will occur for the following: skin assessment, initiation of treatments, notification to the providers verbally via phone or in person or through email, entering orders and documenting in the electronic health record post treatment. Certified nursing assistants observing for skin changes and communication with nursing of skin changes the same day using the point of care documentation: new alert>eInteract Alerts (Stop and Watch)>change in skin color or condition>Save. Nursing staff will review the alert bell in Point Click Care (PCC) for any new alerts related to new skin issues during their scheduled shift. They will complete a head to toe assessment and address new skin injuries/issues as mentioned above per the PCC process. The Treatment Nurse, Charge Nurse or Nurse Manager will carry out the ongoing weekly skin assessments for skin injuries/issues until resolved and may make adjustments to classifications, staging, and treatments as necessary. 8/11/2025-8/12/2025 Surveyors verified through record review, observation, and interviews with staff and administration. 2) How the facility will identify other residents having the potential to be affected by the same deficient practice. On 8/7/25 the Nursing Staff and Nursing Managers initiated a skin sweep to identify any new skin injuries/issues through head-to-toe body audits and documented on the skin monitoring sheets. There were 8 residents with new skin injuries/issues identified. 2/8 residents had pressure injuries, all other identified areas were non pressure. The charge nurses or nurse managers will complete documentation of the areas identified in the EHR, notify the providers, initiate treatments and sign out the treatments in the EHR. Upon completion of the skin sweep the residents with new skin injuries/issues identified, the nurses or nurse managers will document the skin injury/issues in the electronic health record. The resident provider will be notified of the newly identified skin injuries/issues and treatments will be initiated following the provider orders for the skin injuries/issues and documented on the Medication/Treatment Administration Record (MAR/TAR) after completion. On 8/8/25 an audit was initiated to compare the skin assessments post skin sweep to the current census to ensure all residents received a skin assessment. If skin injuries/issues were identified, the PCC process was initiated to include initiation of skin assessments, provider notification, new treatment orders initiated and signed out on the EMAR/ETAR. On 8/8/25 a Quality Service Consultant initiated updating the care plans for any new skin injuries/issues identified from the skin sweep. All residents with skin injuries/issues have the potential to be affected. On 8/7/25 a Quality Service Nurse initiated an audit on current residents with wounds for complete assessments and documentation in the electronic health record, current physician order implementation, and treatments initiated the same day post identification and documented on the EMAR/ETAR. Wound Healing Care Specialist (WHCS) was consulted and initiated their first visits on 4/4/25 and will continue to be consulted weekly for wound assessments and recommendations as needed. If circumstances prevent on site rounds, WHCS will be contacted by phone. The WHCS NP assessed newly identified skin injuries/issues on 8/8/25 with the Facility Treatment Nurse as a follow-up review and will provide any recommendations as needed. On 8/8/25 the IDT to include the Medical Director and Quality Service team updated and reviewed the Treat in Place protocols for Wound Management and the Medical Director approved. Updated Treat in Place protocols initiated and posted at the Nurses Stations for quick reference. On 8/8/25 the Quality Service Consultant initiated an audit for the week of 8/3/25-8/9/25 current residents per the census to determine if a weekly summary assessment which includes a skin assessment was completed and if any skin injuries/issues were noted on the assessment. Any resident identified without a weekly summary assessment documented will have a weekly summary assessment completed and documented by the Nursing Staff. 8/11/2025-8/12/2025 Surveyors verified through record review, observation and interviews with staff and administration. 3) What measures will be put into place or what systemic changes you will make to ensure that the deficient practice does not recur. Wound Healing Care Specialist (WHCS) Nurse Practitioner will round weekly with the Treatment Nurse or designee on residents with identified skin injuries/issues, assess the skin injuries/issues, provide recommendations as needed, and provide the facility with a copy of any WHCS skin assessment. The Treatment Nurse, Charge Nurse or Nurse Manager will complete dressing changes per orders and document on the EMAR/ETAR and complete a weekly skin assessment weekly until skin injuries/issues are resolved. The Treatment Nurse is notified of new skin injuries/issues through a variety of resources such as: through communication with the charge nurses and CNA's, reviewing admission assessments, weekly summary assessments, alert charting, skin assessments, and/or through bell alerts in the EHR. Nurse Managers initiated education to Nurses on 8/7/25 with a post test to ensure competency on the Prevention of Pressure Injuries Policy and the Pressure Injuries Overview Policy. Point Click Care (PCC) process to include identifying and assessing skin injuries/issues through head to toe body audits upon admission using the admission assessment, weekly using the weekly summary assessment and/or skilled residents using the Alert charting. If skin injuries/issues are identified, same day documentation and communication will occur for the following: skin assessment, initiation of treatments, notification to the providers verbally via phone or in person or through email, entering orders and documenting in the electronic health record post treatment. Certified nursing assistants observing for skin changes and communication with nursing of skin changes the same day using the point of care documentation: new alert>eInteract Alerts (Stop and Watch)>change in skin color or condition>Save. Nursing staff will review the alert bell in Point Click Care (PCC) for any new alerts related to new skin issues during their scheduled shift. They will complete a head to toe assessment and address new skin injuries/issues as mentioned above per the PCC process. The Treatment Nurse or designee will carry out the ongoing weekly skin assessments for skin injuries/issues until resolved and may make adjustments to classifications, staging, and treatments as necessary. Nurse Managers initiated education to on duty certified nursing assistants on 8/7/25 on observing for skin changes and communication with nursing of skin changes the same day using the point of care documentation: new alert>eInteract Alerts (Stop and Watch)>change in skin color or condition>Save. Off duty licensed nurses or Agency Nurse upon returning to work are to be educated by the Nurse Managers with post tests to ensure competency on the Prevention of Pressure Injuries Policy and the Pressure Injuries Overview Policy. Point Click Care (PCC) process to include identifying and assessing skin injuries/issues through head to toe body audits upon admission using the admission assessment, weekly using the weekly summary assessment, and/or skilled residents using the Alert charting. If skin injuries/issues are identified, same day documentation and communication will occur for the following: skin assessment, initiation of treatments, notification to the providers verbally via phone or in person or through email, entering orders and documenting in the electronic health record post treatment. Certified nursing assistants observing for skin changes and communication with nursing of skin changes the same day using the point of care documentation: new alert>eInteract Alerts (Stop and Watch)>change in skin color or condition>Save. Nursing staff will review the alert bell in Point Click Care (PCC) for any new alerts related to new skin issues during their scheduled shift. They will complete a head to toe assessment and address new skin injuries/issues as mentioned above per the PCC process. The Treatment Nurse or designee will carry out the ongoing weekly skin assessments for skin injuries/issues until resolved and may make adjustments to classifications, staging, and treatments as necessary. Off duty and Agency certified nursing assistants upon returning to work are to be educated by the Nurse Managers on observing for skin changes the same day and communicating this to the nurses using the point of care documentation: new alert>eInteract Alerts (Stop and Watch)>change in skin color or condition>Save. Newly hired licensed nurses will be educated during orientation with a post test to ensure competency on the Prevention of Pressure Injuries Policy and the Pressure Injuries Overview Policy. Point Click Care (PCC) process to include identifying and assessing skin injuries/issues through head to toe body audits upo