Failure to Update and Implement Comprehensive Care Plan for Resident with Complex Skin Condition
Penalty
Summary
The facility failed to develop and implement a person-centered comprehensive care plan with measurable objectives and timeframes for a resident with complex medical needs. Specifically, the care plan was not updated to reflect the requirement for two-person assistance with bed mobility due to pain caused by autoimmune skin disease, nor did it include physician's orders for treating the resident's autoimmune skin condition. The care plan also lacked documentation of the resident's diagnoses of pemphigus vulgaris and skin peeling, skin sensitivity, and the need for special precautions and treatments such as Prednisone and Silvadene. Observations and interviews revealed that the resident was alert and oriented but suffered from multiple medical conditions, including diabetes mellitus, osteoarthritis, rheumatoid arthritis, pemphigus vulgaris, and a history of Stevens-Johnson Syndrome. The resident had multiple skin lesions, scabs, and rashes, and required total assistance with activities of daily living (ADLs). Staff interviews consistently indicated that the resident needed two people for turning and repositioning in bed due to pain and skin fragility, and that a sheet was required to minimize direct contact with the skin. However, this level of assistance was not clearly documented in the care plan, leading to inconsistent care. On one occasion, a CNA who was not given a proper report or access to the electronic care system provided care to the resident alone, resulting in pain and discomfort for the resident during bed mobility. The CNA was unaware of the need for two-person assistance and the resident's specific care requirements. Family and staff interviews confirmed that the resident experienced significant pain when moved by only one person. The MDS nurses acknowledged that the care plan did not accurately reflect the resident's current needs or physician's orders, and that information was not consistently gathered from all relevant staff.