Failure to Supervise Wound Care and Adhere to Physician Orders for Nutrition
Penalty
Summary
The facility failed to ensure proper supervision and adherence to physician orders for two residents, resulting in deficiencies related to wound care and nutritional monitoring. One resident with a history of cellulitis, chronic respiratory failure, and lymphedema was observed self-performing wound care on the left plantar foot without the use of gloves or clean technique. The resident removed a soiled dressing, applied Lidocaine cream, and changed the dressing without hand hygiene or infection control measures. Staff interviews revealed that the nursing team was not aware the resident was self-administering wound care, and no assessment or education had been provided for self-administration. Additionally, there was no physician order permitting self-administration, and documentation of refusals or observations of poor technique was lacking. Facility documentation showed that previous self-administration evaluations for this resident did not include the current wound care or Lidocaine jelly application. The facility's policy required dressings to be applied by licensed nursing personnel using proper hand hygiene, which was not followed in this case. Staff members, including the LPN and RN, acknowledged that they had not communicated or documented the resident's self-care activities or refusals, and the Director of Nursing was unaware of the situation until the surveyor's inquiry. In a separate incident, another resident with diagnoses of failure to thrive, protein-calorie malnutrition, and congestive heart failure was not weighed daily as ordered by the physician. The care plan required daily weights at a specific time, but review of records showed that weights were only recorded on 7 out of 15 required days. Staff interviews confirmed that daily weights were not completed or documented as ordered, and the facility's policy emphasized the importance of regular weight monitoring to prevent and intervene in cases of undesirable weight loss.