Failure to Assess Skin Impairments and Coordinate Hospice Care
Penalty
Summary
The facility failed to adequately assess and document areas of skin impairment for a resident with multiple diagnoses, including non-Alzheimer's dementia, anxiety disorder, and diabetes. The resident was identified as being at risk for pressure ulcers and had moderately impaired cognition. There was no documentation of assessment or application of bandages for a toe abrasion and a forearm skin tear prior to the dates when these were discovered and recorded. Staff interviews revealed that a CNA had applied bandages, which was against facility policy, and the DON confirmed that CNAs were not permitted to perform this task. Additionally, the facility did not document care planning, collaboration, or communication with hospice services for a resident receiving end-of-life care. The care plan for this resident did not reflect hospice involvement or interventions, despite the resident being on hospice services. There was no evidence that hospice staff were invited to care plan meetings, and the hospice RN confirmed not being invited or notified of changes in the resident's condition or medication orders. The facility's clinical record lacked documentation of communication with hospice regarding significant changes and medication adjustments. There was also a discrepancy between the facility's electronic health record and hospice documentation regarding oxygen orders for the resident on hospice. The facility continued to document and administer oxygen at 2 liters per nasal cannula, while hospice orders specified 5 liters continuous. The facility did not update the EHR to reflect the hospice order, and the DON was unaware of this discrepancy. The facility's contract with hospice required immediate notification of significant changes and coordination of care, which was not documented in these instances.