Failure to Assess, Treat, and Monitor Resident Skin Conditions
Penalty
Summary
The facility failed to provide appropriate treatment and care for a resident who developed significant skin abnormalities, including a rash and redness in multiple areas. Despite the presence of a care plan and specific orders from a wound care nurse practitioner to keep the skin clean and dry, apply barrier and antifungal creams, and monitor the affected areas, staff did not consistently implement these interventions. Documentation shows that the resident's skin issues, including redness and rash in the groin, perineal area, buttocks, and under the breasts, were present for several months without adequate assessment, monitoring, or treatment. Staff did not complete required wound or skin event documentation in risk management, nor did they notify the physician or wound care nurse of changes or worsening conditions. Direct observations revealed that the resident, who was dependent on staff for all activities of daily living and had multiple complex medical diagnoses, was left in a soiled incontinence brief for over four hours. The resident's skin was found to be bright red, with extensive rash and evidence of pain during care. Staff failed to apply barrier cream as ordered, citing lack of access to supplies, and did not follow through with timely application of zinc oxide ointment. The wound care nurse practitioner's recommendations for antifungal and barrier cream application, as well as regular reassessment, were not documented as being followed, and there was no evidence of ongoing measurement or evaluation of the skin condition. The facility's own policies required head-to-toe skin assessments by licensed nurses upon admission, weekly skin checks, daily CNA observations, and prompt documentation and follow-up of any abnormalities. However, there was no documentation of physician notification, wound or skin event completion, or follow-up assessments for the resident's ongoing and worsening skin issues. The lack of adherence to care plans, provider orders, and facility policies resulted in the resident experiencing prolonged pain and discomfort due to untreated and unmonitored skin conditions.