Failure to Complete Physician-Ordered Skin Checks and Timely Identification of Bruising
Penalty
Summary
The facility failed to ensure that services provided met professional standards of quality for one resident with severe cognitive impairment and a history of anticoagulant use. Specifically, the facility did not complete a physician-ordered weekly skin check and did not identify or document bruising on the resident's right arm and forearm for three days. Observations by the surveyor over three consecutive days revealed visible bruising that was not recorded in the resident's weekly skin evaluations or nursing progress notes. The resident's care plan required daily skin inspections and prompt reporting of abnormalities, especially due to the increased risk of bleeding associated with anticoagulant therapy. Interviews with staff confirmed that CNAs are expected to report any observed bruising to nurses immediately, and nurses are responsible for documenting such findings in the medical record. However, the CNA who first noticed the bruise did not report it, and the required weekly skin assessment was not completed as ordered. The Director of Nursing and other nursing staff acknowledged that the skin checks and documentation should have occurred according to policy and physician orders, but these actions were not carried out for this resident.