Failure to Develop Comprehensive Care Plan for Non-Pressure Skin Impairment
Penalty
Summary
The facility failed to provide a comprehensive treatment plan for a resident with altered skin integrity. The resident, who had multiple diagnoses including chronic obstructive pulmonary disorder, diabetes mellitus type two, peripheral vascular disease, congestive heart failure, and atrial fibrillation, was identified as being at risk for skin impairment. Although the care plan included interventions to decrease risk, it did not address the resident's bilateral lower extremities discoloration and dry skin, despite these conditions being observed. The Minimum Data Set did not document any skin impairment, and physician orders were in place for daily skin checks by CNAs and weekly skin assessments by nursing staff. During observations, the resident was noted to have dark blue, cool, and dry, flaky skin on both lower extremities. Interviews with the resident, a CNA, and an LPN confirmed the presence of these skin issues. The LPN acknowledged the findings and indicated that documentation and physician notification would occur, as well as an update to the care plan. However, at the time of the survey, the care plan had not been updated to include interventions for the discoloration and dry, flaky skin, which was inconsistent with the facility's policy requiring monitoring, assessment, and treatment of non-pressure skin impairments.