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F0691
D

Failure to Provide Ordered Colostomy Care

Woodsfield, Ohio Survey Completed on 04-21-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide colostomy care as ordered for two residents who required such services. One resident, admitted with diagnoses including hypertension, pancreatic disorder, and a colostomy, had physician orders for colostomy care to be provided once per shift. Review of the Treatment Administration Records (TAR) showed that colostomy care was documented as completed on only 18 of 35 opportunities in February, 53 of 62 in March, and 24 of 30 in April. The resident's care plan also specified that the ostomy appliance should be changed as ordered. Another resident, admitted with diagnoses including cirrhosis of the liver, diabetes mellitus, diverticulitis, and a colostomy, had orders for ostomy care every shift. The TAR for April indicated that ostomy care was provided on 28 of 30 opportunities. Both residents were assessed as cognitively intact for daily decision-making. During an interview, the Assistant Director of Nursing confirmed that ostomy care was not completed as ordered for these residents.

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