Failure to Provide Comprehensive Wound Care and Maintain Clean Assistive Devices
Penalty
Summary
The deficiency involves the facility’s failure to provide comprehensive wound management and skin care as ordered and care-planned for a resident with vascular disease and chronic ulcers. One resident with chronic left heel vascular ulcer, peripheral vascular disease, and significant mobility and self-care deficits was care-planned to receive heel lift suspension boots at all times (removed only for bathing/hygiene and shift skin checks), weekly wound documentation, and monitoring for infection and changes in wound size. Physician orders also required nightly wound treatments and every-shift skin checks. Record review showed that skin checks were not documented every shift as ordered, and there was no evidence that showers or bathing had been provided during the review period. Surveyor observations on multiple occasions noted a strong foul odor in the resident’s room. During ADL care, staff confirmed the odor and described it as smelling like a “rotten wound.” The resident’s left heel Kerlix dressing appeared clean and intact, but the heel boots were tattered, heavily soiled, flattened, and one was applied upside down; CNAs stated they were unaware of a red open area on the resident’s left mid-calf until it was observed during care. The wound nurse later confirmed this new area and documented it as a skin tear, with subsequent weekly wound documentation identifying additional vascular ulcers on the left posterior calf, left distal calf, and right heel. Progress notes earlier in the same period had stated there were no new skin issues identified. When the wound nurse practitioner arrived for wound rounds, she reported that she had only been informed of one new wound that morning. On assessment, removal of the resident’s sock revealed that a large amount of skin was adhered to the sock and a large open right heel wound with slough and necrotic tissue was present, accompanied by foul odor; the practitioner stated this was a new wound she had not previously been made aware of. Removal of the Kerlix dressing on the left foot revealed another new wound on the left posterior calf several inches above the chronic heel wound, which neither the wound nurse nor the practitioner had known about. The practitioner stated the three new wounds were vascular in nature and did not develop overnight. The resident could not recall when he last had a shower, when his sock was last removed, or when his foot was last cleaned. In a separate finding, another resident’s hand/wrist splint, which was ordered to be monitored for redness and open areas and removable for hygiene, was observed to be heavily soiled with dried dark debris; a CNA acknowledged seeing the soiling and stated it had been that way for a while, yet still applied the splint to the resident’s hand.
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