Failure to Assess, Notify Physician, and Develop Care Plan for Resident's Generalized Itching
Penalty
Summary
A deficiency occurred when a resident with multiple complex medical conditions, including Parkinson's disease, chronic kidney disease, type II diabetes mellitus, and anxiety disorder, experienced ongoing generalized itching without receiving appropriate assessment, care, or timely physician notification. The resident, who had severely impaired cognitive function and required substantial assistance with daily activities, repeatedly complained of itching and was observed with scratch marks and red, flaky skin over several months. Despite these complaints and visible symptoms, there was no evidence that licensed staff performed a thorough skin evaluation or developed a care plan specific to the resident's itching. On multiple occasions, staff, including a Licensed Vocational Nurse (LVN), failed to notify the physician promptly about the resident's worsening condition. The LVN acknowledged not informing the physician immediately after the resident reported whole-body itching and did not provide any treatment or medication for the symptoms. Certified Nurse Assistants (CNAs) observed and reported the resident's persistent scratching and skin damage but only applied lotion without further escalation or intervention. Record reviews confirmed that no medication or treatment orders were in place for the resident's itching, and there was no care plan addressing the issue. The facility's policy required notification of the physician and care plan updates for significant changes in a resident's condition, but these steps were not taken. The Director of Nursing confirmed that the lack of physician notification and absence of a care plan for the resident's itching constituted a failure to provide necessary care and treatment as required by facility policy.