cms_SC: 10215
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 10215 | MAGNOLIA MANOR - INMAN | 425032 | 63 BLACKSTOCK ROAD | INMAN | SC | 29349 | 2010-11-17 | 314 | G | JNTL11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On the days of the survey, based on record reviews, facility policy on care and assessment of Pressure Ulcers, and interview, the facility failed to ensure that a resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing for four of seven sampled residents reviewed for pressure ulcers. Resident # 23 was admitted [DATE] with a known pressure ulcer. treatment for [REDACTED]. Resident # 22 with a known red area to the back, receiving treatment, was not assessed weekly for changes in the area and effectiveness of treatment. Resident #1 failed to have ongoing documentation available of a pressure ulcer as it was treated to allow staff to accurately determine response to the treatment and the need for possible changes in treatment. During a pressure ulcer treatment observed on Resident #3 the licensed staff failed to implement infection control techniques to ensure healing. The findings included: The facility admitted Resident # 23 on 3/6/10 with [DIAGNOSES REDACTED]. On the weekly skin documentation form dated 3/6/10 the resident was documented by nursing to have a black area to the right heel with no further description/measurement noted. On 3/15/10 the area was documented as "soft and black." There was no physician order for [REDACTED]. ... He has a large decubitus over the right heel. It is covered by skin" . He previously had a blister and nursing staff reported that this has drained and there is some serosanguineous type drainage....Small area in the plantar surface of the right foot that is measuring approximately .5cm (centimeter) in diameter Wound bed in this area is pink, moist. This again is a very superficial area ..." The NP at this time ordered vitamin C, Prosource and Vitamin with Minerals, treatments to both areas, continued use of Podus boots, and floating of the heels while in bed. The physician saw the resident on 3/23/10 and made no changes. A care plan for the pressure ulcer to the heel was not developed until 3/18/10 During an interview with the current Unit Manager and the Unit Manager for the unit on which the resident originally resided, revealed that neither nurse could provide evidence the wound(s) noted on admission had been measured or assessed as pressure areas. There was no documentation found that the facility was providing any treatment to the heel wound from 3/6 until 3/18/10. During the interview, the unit manager stated- "It should have been skin prepped. Anything black we always skin prep to off with." On 3/22/10 a "dark area" to the bottom of the right foot was documented on the weekly assessment form. However, an order was written previously on 3/9/10 to apply skin prep to the ball of the right foot bid until healed (stage I decubitus) . There was no documentation per facility provided policy to include: " location, measurement, appearance, drainage, odor, color, presence of undermining/tunneling, healing, stage if a pressure ulcer, pain and [MEDICAL CONDITION].The resident's admission care plan noted on 3/8/10 the presence of a stage I - "ball of RH foot (?right heel) -skin prep ball of rh foot as ordered." Resident # 22 was admitted to the facility with Arthritis and Bullous Lung Disease. On 6/12/10 a weekly skin assessment noted the resident had a "pink" area to the bony prominence of the mid back and sacral area. On 6/27/10 an order was obtained for Optofoam pad, cover with [MEDICATION NAME] every three days for protection to mid back bony prominence area. On 11/15/10 at 11AM, during an interview with the Unit Manager, she stated although weekly skin assessments were completed, they were done by the weekend nurse who would be unable to see thru the Optofoam pad to visualize the area. There was no documentation that the area was measured. On 11/17/10, during an interview with the Director of Nursing, she verified that a red/pink area over a bony prominence would meet the definition of a Stage I pressure area. She stated she would have expected the area to be measured weekly and to have been included in the pressure ulcer reports submitted to her office. After checking the pressure ulcer records on file in her office, the Director of Nursing stated the resident was not and had not been included in the pressure ulcer reports. Further review of the treatment flow sheet for October 2010 revealed there were no signatures present for the application of the treatment to the back from from 10/17 to 10/29/10. On 11/15/10 at 11AM, during an interview, the Unit Manager and the nurse responsible for the application of the treatment verified there was no documentation that the dressing had been applied per the order. Resident #22 was seen by the Nurse Practitioner (NP) on 11/8/10 who commented: ..."The family was somewhat concerned.... The buttocks area and gluteal cleft are inspected. There is some pinkness in the superior aspect of the gluteal cleft. She has a very prominent coccyx, and some pinkness over these and open areas. ...Upper back approximately T8 through T 12 is pink. She has a foam dressing on, which was removed, and there is some mild what appears to be fungal -type changes to the skin, redness and pinkness, which again blanched, while there are no open areas....." The resident was diagnosed by the NP with a stage I decubitus to the Sacrococcygeal area and started on Vitamin C. The treatment to the mid back was changed at that time. The Facility provided policy for Staging pressure ulcers (Revised 6/08) stated: A stage I pressure ulcer was defined as "intact skin" and a Stage II pressure ulcer was a "partial loss of dermis..." The policy also stated that wounds will be evaluated/documented to include: " location, measurement, appearance, drainage, odor, color, presence of undermining/tunneling, healing, stage if a pressure ulcer, pain and [MEDICAL CONDITION].Treatments should be re-evaluated every 2-3 weeks. If no wound progression noted treatment change should be considered. If no change in treatment done documentation should occur as to why current treatment maintained." The facility admitted Resident #1 on 7/07/10 with [DIAGNOSES REDACTED]. Record review on 11/16/10 revealed the resident to be receiving treatments of Santyl ointment to right heel and wrap for a pressure ulcer. The last documentation found in the record was dated 9/03/10 showing a measurement of 4 cm ( centimeters) by 6 cm 1/2 sealed off pink brown lower area- 1/2 dark purple with surrounding skin normal. On 9/17/10 the wound measured .3 by .8 had scant amount of yellow drainage. An interview with RN #1 (Registered Nurse) revealed she did not do the daily dressings but measured all the wounds weekly. She stated, "I have a sheet I document all the information on and give a copy to the DON (Director of Nursing). I am supposed to transfer the information to each resident's individual Wound Treatment & Progress Record weekly. I goofed. I have not always documented weekly on the individual sheets." The nurses doing the dressings had nothing to compare with in order to make recommendations about continuing or changing treatments. The nurses assigned to do the treatments were the staff nurses on duty each day and not the same nurse each day. There was no continuity of care in treating the wound. The facility admitted Resident #3 on 6/23/10 with a [DIAGNOSES REDACTED]. During an observation of wound treatment for [REDACTED].#3 failed to wash or sanitize her hands between removal of the soiled dressing from the Stage III wound on the top of the left foot and placement of the clean dressing. LPN #3 stated that the dressing was saturated with "yellow, bloody drainage". Prior to placement of the clean dressing, the nurse removed scissors from her pocket and cut a foam dressing for use on the wound without disinfecting or cleaning the scissors prior to use. The dressing was then applied to the Stage III wound. Prior to the wound treatment to the Stage II wound on the left buttock, when the resident was positioned onto her right side, the underpad was noted to be soiled with a red tinged drainage. LPN # 3 stated, "This could be a vaginal drainage". After removal of the soiled dressing, the resident was allowed to turn back onto her back on the underpad without a dressing to the open wound on the left buttock. When the resident was turned back for placement of the clean dressing, an area of red tinged drainage the size and shape of the wound was noted on the soiled underpad. On 11-17-10 at 1:05 PM the Staff Development Coordinator (SDC) provided a facility policy entitled, "Dressing-Absorption Dressing, Application of". Step #10 stated: "Disposes of soiled dressings appropriately. Removes gloves and disposes. Washes hands." The policy then continued with the preparation and application of the clean dressing. An interview was conducted with LPN #3 on 11-17-10 at 12:40 PM. The nurse verified all the above observations and stated, "I messed up with glove changing and handwashing." The nurse stated that she cleaned the scissors prior to placing them in her pocket and she was unaware that the scissors should be cleaned prior to each use. | 2014-03-01 |