Failure to Timely Treat and Document Skin Rash in Resident
Penalty
Summary
Staff failed to provide timely treatment and care for a resident who developed a rash, as required by facility policy and the resident's care plan. The resident, who had diagnoses including dementia, schizophrenia, and anxiety, was identified as being at risk for impaired skin integrity and had a history of moisture-associated skin damage in the abdominal folds. Weekly skin observation tools documented redness and yeast under the resident's breasts and abdominal folds, but there was no documentation of physician notification or timely application of prescribed Nystatin cream during multiple periods when the rash was observed. The resident's care plan required weekly skin assessments, physician notification of new skin impairments, and implementation of treatment orders. Despite this, staff did not document applying the as-needed Nystatin cream to the affected areas from the time the rash was first observed until several weeks later. Additionally, there was no documentation in the progress notes explaining why the treatment was not administered, nor was there evidence that the physician was notified of the change in the resident's skin condition during this period. Interviews with staff, including an LPN and the DON, confirmed that the resident frequently developed yeast rashes and had an as-needed order for Nystatin cream, which later became a scheduled treatment. However, the DON was unaware of the delay in treatment, and the Administrator stated that staff should assess, document, and notify the physician when new skin issues are identified. The lack of timely treatment and documentation constituted a failure to follow facility policy and the resident's care plan.