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Treatments had been discontinued without orders or notations in the record that these wounds had resolved/healed.

LAKE EMORY POST ACUTE CARE

LOCATED: 59 BLACKSTOCK ROAD, INMAN, SC 29349

LAKE EMORY POST ACUTE CARE was cited by the DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES for the following deficiencies:

PLEASE NOTE: The following highlighted quoted text is only a portion of the full report/survey submitted by DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES. The full report/survey can be found here.

FACILITY FAILED TO GIVE RESIDENTS PROPER TREATMENT TO PREVENT NEW BED (PRESSURE) SORES OR HEAL EXISTING BED SORES.

LEVEL OF HARM –ACTUAL HARM

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview, the facility failed to ensure nursing staff provided appropriate care and services related to pressure ulcer treatment and wound documentation for Resident #56, 1 of 3 sampled residents reviewed with pressure ulcers. There were no wound measurements, staging, or descriptions of the resident’s pressure ulcers noted on re-admission to the facility on [DATE]. Wound measurements and/or staging were not documented in the record until 1/23/15. There was no documentation that wound treatment orders had been clarified with the physician upon re-admission to the facility. Wounds documented on the re-admission body audit did not match the treatments that had been restarted by the facility. A left lateral foot pressure ulcer noted on re-admission did not have a treatment initiated. Physician’s orders [REDACTED]. Treatments had been discontinued without orders or notations in the record that these wounds had resolved/healed. Wound documentation indicated that the resident’s pressure ulcers were not healing and/or had worsened.

A review of the December 2014 Treatment Administration Record revealed the Normal Saline wet to dry treatments noted on the hospital transfer summary had not been continued. Previously ordered facility treatments (to the resident’s left buttocks, left ischium, right elbow, and right hip; along with skin prep to the left elbow, toes, and bilateral heels) had been continued on 12/24/14 without orders from the physician or documentation that the resident’s wounds had been evaluated by facility staff to determine if these treatments were still appropriate. There were no documented wound measurements or staging of the wounds on re-admission. The facility was unable to provide documentation that this had been done until 1/23/15. According to the wound nurse, this is the date that s/he started. Prior to this date, the floor nurses were responsible for the wound care. The wound nurse was unaware of any prior documentation of wound measurements from the resident’s re-admission to the facility on [DATE].

The wounds documented by the nursing staff on the body audit and in the Nurse’s Notes on re-admission to the facility did not match all the areas of the body where the treatments had been continued on 12/24/14. According to the re-admission body audit, there was an open area on the resident’s left lateral foot, but there were no orders initiated for a treatment to this area until 1/23/15. The first wound measurements and staging for this left lateral foot wound had not been documented until 1/23/15 at which time it had been documented as a stage II pressure ulcer that measured 1.1 cm by 2 cm. There were no treatments to the left lateral foot that had been documented on the Treatment Records until 1/23/15.

Personal Note from NHA-Advocates: NHAA shares with all the families of loved ones who are confined to nursing homes the pain and anguish of putting them in the care of someone else. We expect our loved ones to be treated with dignity and honor in the homes we place them. We cannot emphasize enough to family members of nursing home residents; frequent visits are essential to our loved ones’ well-being and safety. This nursing home and many others across the country are cited for abuse and neglect.

You can make a difference. If you have a loved one living in this nursing home or any other nursing home where you suspect any form of abuse or neglect, contact us immediately.

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Contact us through our CONTACT FORM located on our website here below or on the sidebar or call our toll free hot line number: 1-800-645-5262.

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