F0684

E

Failure to Provide Ordered Rash Treatments and Timely Dermatology Consultations

Burbank, California Survey Completed on 02-21-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide skin treatments and specialty consultations as ordered, and to obtain necessary physician orders, for three residents with rashes. For one resident with schizoaffective disorder, dementia, and chronic hepatitis B, a skin reassessment on 1/15/2026 documented rashes on the chest and abdomen, and a physician order was in place to cleanse the rash and apply hydrocortisone 1% cream on the day and evening shifts for four weeks. Review of the Treatment Administration Record (TAR) for 1/2026 showed blank entries for the ordered treatment on multiple shifts, and both the Registered Nurse Supervisor and the MDS nurse stated that blank TAR entries meant the treatment was not provided or signed. Facility policy on administering medications required that medications and treatments be administered in accordance with prescriber orders and documented with date, time, dosage, route, and the initials/signature of the person administering.

A second resident, admitted with Parkinson’s disease, dementia, and unspecified dermatitis, had a physician order dated 10/2/2025 to cleanse generalized rashes on the bilateral upper and lower extremities and chest with normal saline and apply clotrimazole-betamethasone cream on day and evening shifts for four weeks. Wound care NP notes on 10/28/2025 and 11/11/2025 documented generalized dermatitis and a plan to cleanse with normal saline and apply clotrimazole 1% and betamethasone 0.05% cream twice daily. However, the November 2025 TAR showed no treatment documented from 11/1/2025 to 11/13/2025. Treatment Nurse 1 stated that the resident still had rashes during that period, that the treatment order had not been renewed, that there was no documented physician order for the rash during those dates, and that no treatment was provided. The RNS and MDS nurse confirmed that without a physician order and documentation, the rash treatment was not provided for 13 days, despite facility policies on administering medications, non-pressure sore management, and alteration in skin integrity that required assessment, physician notification, and treatment orders for skin alterations.

The same resident had an order on 5/17/2025 for a dermatology consultation and follow-up treatment as indicated, but wound care notes from 2/25/2025 through 12/25/2025 repeatedly documented generalized fungal or unspecified dermatitis without any documentation that a dermatologist evaluated the resident. The Infection Preventionist confirmed that the resident was transferred to an acute care hospital on 1/16/2026 with body rashes, and Treatment Nurse 1 stated the resident was never seen by a dermatologist and was only seen by the wound care NP. The RNS stated that the dermatologist did not assess the resident’s rashes from the date of the order until transfer, a period of almost eight months, and that the NP was a wound care specialist, not a dermatologist. The NP reported that he had raised the issue of scabies testing and treatment with the DON before 12/25/2025 but was told not to order scabies tests or aggressive treatment because of concerns about a potential scabies outbreak and staffing, and that the facility intervened to prevent him from ordering scabies tests and treatment. Facility wound care policy required verification of a physician’s order for wound procedures, and the submitted scabies prevention guideline called for access to clinicians experienced in recognizing scabies and confirmation by skin scraping.

A third resident, admitted with cerebral infarction, dementia, and pneumonia, had an order dated 12/25/2025 for a dermatology consult and follow-up treatment as indicated. A skin reassessment on 12/26/2025 documented rashes on the bilateral upper and lower extremities, chest, and back, and a care plan dated 1/5/2026 included an intervention to notify dermatology of non-response. Skin rash reports on 1/9/2026 and 1/24/2026 documented ongoing rashes, and the TAR for 1/2026 showed the resident received triamcinolone twice daily for dermatitis throughout the month. Treatment Nurse 1 stated this resident was the roommate of the resident later confirmed with scabies in the hospital, had rashes since 12/26/2025, and was not seen by a dermatologist until 1/26/2026, when the dermatologist came to evaluate multiple residents with rashes after the other resident’s positive scabies test. The RNS stated the facility should have followed the physician order for dermatology consultation and that a one-month delay in notifying dermatology could worsen the resident’s rashes. Treatment Nurse 1 further stated that RNs obtain dermatology consultation orders and notify dermatology by fax or phone, but she did not call because the facility did not have a dermatologist until 1/26/2026. Facility policies on non-pressure sore management and change in condition required physician notification and follow-through when residents developed rashes, and the RNS stated that when this resident developed rashes on 12/26/2025, a change in condition should have been created and the physician order followed.