F0658

E

Failure to Administer Ordered Antifungal Treatments and Delay in Obtaining Rash Treatment Orders

Bell Gardens, California Survey Completed on 02-27-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that ordered treatments for fungal skin infections were administered as prescribed for one resident. One resident with intact decision-making capacity and no cognitive impairment had physician orders dated 1/26/2026 for cleansing a rash with normal saline, patting dry, and applying Triamcinolone 0.5% cream topically under both breasts every day and evening shift for 14 days to treat candidiasis. Review of the Treatment Administration Record (TAR) for January 2026 showed that the evening doses on 1/27, 1/28, 1/29, and 1/31 were not documented as given. Subsequent physician orders dated 2/9/2026 directed cleansing with normal saline and application of Nystatin powder and Triamcinolone cream to the buttocks and perineal area every day and evening shift for candidiasis. The February 2026 TAR showed missed evening treatments on 2/11, 2/12, and 2/19. During interviews, an LVN and the treatment nurse confirmed that the resident did not receive all ordered evening treatments and doses of Nystatin and Triamcinolone during these periods.

The deficiency also includes the facility’s failure to promptly obtain treatment orders for another resident who reported a new itchy rash. This resident, with pneumonia and epilepsy and moderate cognitive impairment, complained on 1/31/2026 of itchiness to the groin area with red, raised rashes. A progress note documented that the physician was called and that staff were awaiting a response on needed treatment. Review of progress notes, TARs for January and February 2026, and the 24-hour report sheet showed no documentation that the physician was successfully reached regarding the rash on that date, and no treatment orders were in place at that time.

In a subsequent interview and record review, an LVN stated there was no supporting documentation that nurses were able to reach the physician about the rash identified on 1/31/2026 and that treatment orders were not obtained until 2/6/2026, six days after the initial complaint. The DON, upon review of the TARs, progress notes, and 24-hour report, stated that nurses did not administer all ordered doses of Nystatin and Triamcinolone for the first resident in January and February 2026 and acknowledged that all treatments should have been administered as ordered. The DON also stated that staff should have communicated to the upcoming shift when waiting for physician orders and characterized the six-day delay in obtaining orders for the second resident’s rash as a delay of care. Facility policies on medication administration and change in condition required medications to be administered as ordered and prompt physician notification when there is a need to significantly alter a resident’s medical treatment.