Failure to Re-Evaluate and Revise Dermatitis Care Plan
Penalty
Summary
The deficiency involves the facility’s failure to re-evaluate and revise a resident’s care plan for dermatitis as scheduled. A resident with a history of atrial fibrillation and atrial flutter, who had capacity to make decisions per a prior H&P and later showed moderate cognitive impairment on the MDS, was observed with a generalized rash on the back and reported having the rash for about a year with itchiness, especially at night. Physician’s orders dated 11/21/2025 directed cleansing the rash with normal saline and applying ketoconazole cream every shift and triamcinolone cream on day shift to the trunk for 30 days. A corresponding care plan for dermatitis of the trunk, initiated on 11/21/2025, set a goal that the resident would have no complaints of scaly, flaky, itchy, red skin for 30 days and no allergic reaction to the topical medications, and specified that a re-evaluation should occur on 12/21/2025. Review of the resident’s progress notes for 12/2025 showed no documentation that the treatment and plan of care were re-evaluated on the 12/21/2025 target date. During interviews, the treatment nurse stated that skin assessments are done daily and at the end of treatment, and that when treatment ends staff should notify the wound consultant to determine whether orders should be continued or changed, but acknowledged that this resident’s plan of care was not revised or re-evaluated on 12/21/2025 to determine if the dermatitis had resolved. The DON similarly stated that the treatment nurse should reassess whether a resident’s plan of care and treatment are working and document the re-evaluation in the progress notes, and confirmed that if the care plan was not re-evaluated after the target date, the resident’s skin condition could have worsened. The facility’s comprehensive care plan policy requires measurable objectives, timeframes, and documentation of alternative interventions as needed, but the required re-evaluation and potential revision of the dermatitis care plan were not completed or documented for this resident.
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