Failure to Identify and Treat Moisture-Associated Skin Damage Behind Ears
Penalty
Summary
The deficiency involves the facility’s failure to provide treatment and care in accordance with professional standards, the resident’s care plan, and the resident’s assessed needs, specifically related to skin integrity. The resident was an older adult with hypertension, hyperlipidemia, shortness of breath, pneumonia, and respiratory failure, and had an order for continuous oxygen at 4 L/min via nasal cannula. The annual MDS showed the resident was rarely/never understood, had short- and long-term memory problems, and required substantial/maximal assistance for personal hygiene and transfers. The care plan identified the resident as being at risk for pressure injuries related to immobility, with interventions to follow facility policies for prevention and treatment of skin breakdown and to inform the resident/family of any new skin breakdown. On a weekly skin assessment dated 2/25/26, the Treatment Nurse documented that the resident had no bruises, skin tears, abrasions, lacerations, or moisture-associated skin damage, and under “other skin issues” only noted two wounds on the resident’s right hand. No other skin conditions were identified at that time. However, photographs taken by the resident’s family member on 2/20/26 showed both ears to be raw, with broken, red skin where the ears met the scalp at the top, indicating moisture-associated skin damage behind both ears that predated the weekly skin assessment. The Hospice RN reported that during a visit on 2/24/26, she observed skin breakdown behind both ears and notified the hospice physician about obtaining orders for ear protectors, and later called the facility on 2/26/26 to ask if any orders for the ears had been received. On 2/27/26, staff interviews revealed that the Treatment Nurse and RN B were only aware of wounds on the resident’s hand and denied knowledge of any other skin breakdown, and a CNA also reported not seeing any skin breakdown or rashes. Direct observation of the resident’s ears that same day showed scabbed areas, redness, raw skin, and peeling where both ears met the scalp. A progress note later on 2/27/26 documented blanchable redness behind both ears and new orders from a nurse practitioner for zinc oxide and ear protectors. A subsequent order dated 3/9/26 for Nystatin powder to the bilateral backs of the ears for moisture-associated skin damage was also noted. The DON and Treatment Nurse both stated they did not believe anything was missed during the 2/25/26 skin assessment, despite the earlier family photographs and hospice nurse report showing ear breakdown prior to that assessment, and the lack of treatment for the ear skin damage between 2/20/26 and 2/27/26.
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