Failure to Develop and Implement Care Plan for Maggot Infestation
Penalty
Summary
A resident with advanced dementia, chronic left facial mass (squamous cell carcinoma), and multiple comorbidities was observed to have a maggot infestation on the facial mass. The resident had a history of refusing treatment for the facial mass, which had been present and growing for at least two years. Despite the presence of a care plan for impaired skin integrity and infection risk, there was no specific care plan or consistent interventions documented for the management of maggots on the resident's facial mass. Nurses' notes and care plans did not consistently address the presence, monitoring, or treatment of maggots, and there was a lack of documentation regarding the number of maggots or the effectiveness of interventions. The facility failed to investigate the cause of the maggot infestation and did not develop or implement a comprehensive plan of care to address the infestation or the resident's refusals of care. Staff interviews revealed inconsistent awareness and documentation of the maggot issue, with some staff reporting direct observation of maggots and others denying any knowledge. The Director of Nursing and RN Supervisor were unable to provide evidence of an investigation into how the infestation occurred or how it was being managed, aside from sporadic notes and a brief incident report that lacked detailed follow-up or staff interviews. Throughout the period of infestation, there was no consistent monitoring or progress notes regarding the presence or removal of maggots, and interventions were sporadic and not clearly documented in the care plan. The lack of a specific maggot care plan, inconsistent monitoring, and absence of a thorough investigation into the infestation represent a failure to provide treatment and care in accordance with professional standards of practice and the resident's needs.