MANORCARE HEALTH SERVICES-AKRON
FACILITY FAILED TO PROVIDE APPROPRIATE PRESSURE ULCER CARE AND PREVENT NEW ULCERS FROM DEVELOPING.
State Findings:
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interviews, resident interview, and record review, the facility failed to ensure one resident (Resident #49) had pressure ulcer prevention interventions in place, failed to timely assess a change in skin integrity, and failed to implement wound treatment in a timely manner. Actual harm occurred when Resident #49 was discovered with three unstageable pressure ulcers to his heels.
Review of the admission Minimum Data Set 3.0 (MDS) assessment, dated 12/10/18 revealed Resident #49 was cognitively intact and required extensive assistance of two staff for bed mobility and transfers. The assessment indicated the resident had no pressure ulcers.
Interview on 12/17/18 at 2:20 P.M. with Resident #49 revealed he told the Nurse Practitioner (NP), the last time she saw him that he had a black spot on his foot and she told him to tell Registered Nurse (RN) #240. Resident #49 stated RN #240 was going to check it on 12/14/18 but did not look at it. Resident #49 stated no one had addressed his concern of the black spot on his foot and he had not received any [MEDICATION NAME] powder for his groin.
An additional observation on 12/17/18 at 2:45 P.M. of Resident #49’s heels with RN #240 revealed two pressure areas on the left foot and one pressure area on the right foot. RN #240 verified that the areas were related to pressure.
Interview on 12/17/18 at 3:07 P.M. with Certified Nurse Practitioner (CNP) #223 revealed Resident #49 was one of her residents and she had seen him on 12/10/18. CNP #223 stated Resident #49 told her that his heel hurt, and she told him to tell RN #240. CNP #223 stated she spoke to the nurse about his heels and asked if he had any open areas. CNP #223 said she had not documented anything on her progress notes about the concern with is heels. CNP #223 stated Resident #49 wore compression stocking for his [MEDICAL CONDITION] and staff put them on and take them off daily and should have noticed any change in skin condition of his heels. CNP #223 verified she did not look at Resident #49’s heels.
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