Failure to Assess and Care Plan Dry Skin for a Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident with documented dry skin was properly assessed and care planned by nursing staff with the appropriate competencies and within their scope of practice. On admission, Resident 2’s initial assessment documented excessive dry skin on the face and bilateral lower extremities. The resident had significant medical diagnoses including sequelae of cerebral infarction, diabetes mellitus, and heart failure, and the MDS later documented mild cognitive impairment and a need for assistance with multiple ADLs. Despite the documented dry skin at admission, there were no physician orders for skin ointments or protectants for dry skin in the resident’s record over several months. Review of Resident 2’s care plans showed there was no care plan addressing dry skin, even though the ADON stated that dry skin is considered a skin abnormality that must be care planned. The ADON confirmed that Resident 2 was admitted with dry skin to the face and both legs but that this condition was not reflected in the care plan. Additionally, weekly head‑to‑toe assessments completed by night shift charge nurses on multiple dates did not indicate the presence of dry skin, which the ADON acknowledged was inaccurate. This demonstrated that the ongoing assessments did not accurately capture the resident’s skin condition. Interviews with staff further clarified the facility’s assessment and reporting processes. An LVN stated that A + D ointment is typically ordered for residents with dry skin and that CNs report skin abnormalities to charge nurses, who then assess residents and report changes in condition to the RN Supervisor. The RN Supervisor stated that full body assessments are completed on admission, readmission, or change of condition. Facility job descriptions for LVNs and RNs emphasized providing nursing care within the scope of practice and ensuring baseline and periodic comprehensive assessments and care plans are completed. The facility’s care plan policy required that identified problem areas and risk factors be incorporated into comprehensive care plans and that assessments be ongoing with care plans reviewed and revised as new information emerges. The Board of Vocational Nursing and Psychiatric Technicians guidance indicated that LVNs cannot perform certain types of assessment, underscoring that a licensed nurse with the appropriate skill set did not complete or document an accurate assessment and care plan for Resident 2’s dry skin.
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