MADISON, TN – SIGNATURE HEALTHCARE OF MADISON

Based on facility policy review, medical record review, service reports, observation, and interview, the facility failed to prevent neglect for 3 (#1, #16, and #22) of 38 residents reviewed. The facility failed to provide needed care and services to prevent the infestation of fly larvae (maggots) in subcutaneous tissue (underneath the skin) and under skin folds for 1 (#22) of 5 residents reviewed. The facility failed to monitor and document bowel movements and failed to administer appropriate bowel medications for 12 (#1, #5, #7, #10, #16, #19, #21, #24, #25, #29, #36, #37) of 15 residents reviewed for bowel movements. The facility failed to prevent actual abuse to 1 (#23) of 38 residents reviewed. Actual Harm occurred when Residents #1 and #16 complained of severe abdominal pain and constipation necessitating a visit to the hospital. The facility’s non-compliance resulted in Residents #1 and #16 psychological and physical harm.

This failure placed Resident #22 in Immediate Jeopardy (a situation in which the provider’s non-compliance with one or more requirements of participation has caused, or is likely to cause serious injury, harm, impairment, or death to a resident).

The Administrator, Interim Director of Nursing, Corporate Nurse and Corporate Vice President of Operations were notified of the Immediate Jeopardy on [DATE] at 4:00 PM in the Social Worker’s office.

An acceptable Allegation of Compliance was received on [DATE] at 8:45 PM which removed the immediacy of the jeopardy. Corrective actions were validated through review of documents, observations, and staff interviews conducted onsite on [DATE]. The Immediate Jeopardy was effective from [DATE] – [DATE]. F689 is Substandard Quality of Care. Noncompliance continues at a scope and severity of D to monitor the effectiveness of the corrective actions.

Telephone interview with CNA (Certified Nurse Aid) #3 on [DATE] at 12:14 PM revealed on [DATE] CNA #3 went to Resident #22’s room to give the resident a bed bath. The CNA was asked by Resident #22 to perform a light wash (not too vigorous cleansing) due to increased pain in his hip. As CNA #3 began to wash the right hip with a wash cloth and soapy water, maggots were noted coming from the right thigh area crawling on the resident’s abdominal folds. Continued interview with CNA #3 revealed he stopped cleaning the area and notified Licensed Practical Nurse (LPN) (Wound Care Nurse) #1 and the Administrator. He asked CNA #2 to help him. Both CNA #2 and CNA #3 returned to the room and he removed the covers to show CNA #2 the maggots. LPN #1 left the room and returned with a brown bottle of Dakin’s (A dilute hypochlorite (bleach) antibiotic solution that kills the micro-organisms, but also harms healthy cells in all concentrations) and a toothbrush to cleanse the wound and skin folds and to remove the maggots. Further interview with CNA #3 revealed LPN #1 told both CNA #2 and CNA #3 to pour the Dakin’s solution on the plaques and fissures to clean the area with the solution and the toothbrush. Further interview with CNA #3 revealed the maggots looked medium to large. Continued interview with CNA #3 revealed Resident #22 could feel the maggots crawling once they came out of the wound. CNA #3 stated Resident #22 said, .I feel them, I feel them .

Interview with LPN #1 on [DATE] at 3:21 PM in the West dining room revealed LPN #1 was requested in the room because Resident #22 thought he had maggots .and the resident requested to go to the hospital . Continued interview with LPN #1 revealed Resident #22 had [MEDICAL CONDITION] in the area where the maggots were located. The area had been raised and bumpy.

Continued interview with LPN #1, the wound care nurse, revealed when asked how often she checked the site of the [MEDICAL CONDITION] LPN #1 stated .I don’t look at it every day. I just go and check on Resident #22 once a week .

Telephone interview with CNA #3 on [DATE] at 2:01 PM revealed Resident #22 complained of pain for about 3 weeks prior to the maggots coming out of the plaques and fissures and there were times when staff had to alter how they cleaned the area because it was so painful for the resident.