cms_NE: 71
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 71 | HOMESTEAD REHABILITATION CENTER | 285049 | 4735 SOUTH 54TH STREET | LINCOLN | NE | 68516 | 2019-09-30 | 686 | D | 0 | 1 | UZYC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D2b Based on observation, record review, and interview the facility failed to ensure that staff followed the standard of practice for wound care for pressure ulcers (an injury to the skin and underlying tissue resulting from prolonged pressure on the skin), and the facility failed to document weekly assessment details for required wound assessment of a facility acquired pressure ulcer for 1 resident (Resident 21) of 1 resident observed. The facility census was 123. Findings are: [NAME] Record review of the physician Referral Form dated 8/29/19 confirmed that Resident 21 had a decubitus (pressure) ulcer on the 4th digit (toe) of the left foot. Record review of the facility procedure titled Wound Care dated (MONTH) (YEAR) revealed the following steps: 1. Use disposable cloth (paper towel is adequate) or disposable plastic cover to establish clean field on resident's over bed table or other appropriate area. Place all items to be used during procedure on the clean field. 6. Put on clean gloves. 7. Use tongue blades or applicators to remove ointments and creams from their containers. Observation of wound care on 9/25/19 at 1:13 PM revealed Licensed Practical Nurse D (LPN D) entered Resident 21's room and removed the band aid from the resident's left 4th toe. A wound was observed on top of the resident's left 4th toe that was approximately 1 centimeter x 0.3 centimeter in size per visual measurement that was yellow and dry in the center with light red tissue around the wound edges. LPN D placed the container of Silver [MEDICATION NAME] 1% cream (a topical antibiotic used on skin wounds to prevent infection) directly on the seat of the chair near the resident's bed along with two bandages with no cloth or barrier on the chair. LPN D performed soap hand washing and obtained a wash cloth with soap and water and cleaned the wound area on the top of the left 4th toe. LPN D dried the area lightly with a new wash cloth. LPN D put a glove on the right hand and squeezed the Silver [MEDICATION NAME] 1% cream from the tube directly onto the glove and then applied the cream to the 4th left toe wound. LPN D removed the glove from the right hand and discarded it. No hand washing was performed. LPN D applied a band aid to the resident's left 4th toe to cover the wound. LPN D gathered the cream and the soiled wash cloths and exited the resident room and walked to the soiled room on the 100 hall. LPN D entered the soiled room and then exited holding the cream container. LPN D walked to the 200 nurse station and started to chart on the computer at the nurse's station. Interview on 9/25/19 at 4:14 PM with the Clinical Services Consultant (CSC) confirmed that staff should use a q tip or something else to get the cream or ointment from the container to apply to the wound and not apply the cream or ointment to a glove for application. B. Record review of the physician Referral Form dated 8/29/19 revealed that Resident 21 had a 0.2 centimeter decubitus ulcer on the 4th digit of the left foot. Record review of the facility policy titled Skin Assessments and Pressure Ulcers/Skin Breakdown-Clinical Protocol dated (MONTH) (YEAR) revealed step 3a: Weekly skin assessments will be completed by the nurse and documented in the EHR (electronic health record). Record review of the facility Weekly Skin Assessment (a tool used to thoroughly document the assessment of a wound) revealed a section to document any skin issues present, a section directing the nurse to document the wound size (length x width X depth) for any skin issue present, and a section to document the character of the wound bed. The Weekly Skin Assessment also contained a section to describe the following: odor, pain, color, drainage, and surrounding tissue. Record review of the facility Weekly Skin assessment dated [DATE] for Resident 21 identified the pressure ulcer on the 4th digit (toe) of the left foot. The Weekly Skin Assessment contained no documentation of the wound size, character, or descriptions of the wound. Record review of the facility Weekly Skin assessment dated [DATE] for Resident 21 identified the pressure ulcer on the 4th digit (toe) of the left foot. The Weekly Skin Assessment contained no documentation of the wound size, character, or descriptions of the wound. Record review of the facility Weekly Skin assessment dated [DATE] for Resident 21 identified the pressure ulcer on the 4th digit (toe) of the left foot. The Weekly Skin Assessment contained no documentation of the wound size, character, or descriptions of the wound. Interview on 9/25/19 at 4:14 PM with the Clinical Services Consultant (CSC) confirmed that weekly skin assessments are completed for follow up of resident wounds and that the weekly skin assessment should contain a description and measurements of the wound. Interview with the Director of Nursing (DON) on 9/26/19 at 10:44 AM confirmed that Resident 21 had a pressure ulcer identified on the facility Nurses Weekly Skin assessment dated [DATE] and that the assessment did not include documentation of the wound size as directed by the assessment. The DON confirmed that the facility Nurses Weekly Skin Assessments dated 9/9/19 and 9/16/19 identified the resident pressure ulcer and did not include documentation of the wound size as directed on the assessment. | 2020-09-01 |