Failure to Provide Necessary Care for Resident with Intellectual Disabilities and Skin Picking
Penalty
Summary
A resident with a history of traumatic subarachnoid hemorrhage, mild intellectual disabilities, and unspecified dementia with agitation was not provided with adequate care and services to address persistent scratching and picking at their arms and legs. The resident's care plan acknowledged communication challenges and included interventions for skin picking, such as the use of hydroxyzine and physical barriers like geri sleeves. Physician orders specified washing and applying lotion to the arms, using geri sleeves or tubi grip, and administering hydroxyzine as needed for itching and skin picking. Despite these interventions, clinical records and observations documented ongoing open areas, scratch marks, and active bleeding on the resident's extremities. Staff interviews revealed that the resident lacked the cognitive ability to request PRN (as needed) medications, and nursing staff administered hydroxyzine only when they observed scratching behavior. Both the LPN and RN confirmed uncertainty about why the medication was ordered as PRN rather than scheduled, given the resident's inability to communicate their needs. The facility's policy required individualized care for residents with intellectual disabilities, but the care provided did not ensure consistent management of the resident's skin picking behavior, resulting in preventable discomfort and risk of skin breakdown.