WILMINGTON, DE – CADIA REHABILITATION PIKE CREEK

Based on record review, interview, and review of other facility documentation, it was determined that for two (2) (R51 and R84) out of four (4) sampled residents reviewed for hospitalization and one (1) (R209) out of three (3) sampled residents for nutrition, the facility failed to ensure that residents received the treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan. For R51, the facility failed to notify the physician/nurse practitioner of refusal of ordered labs, failed to re-educate R51 about the health risks of refusing labs, and failed to re-attempt to obtain the labs during a 39 day span. The facility failed to adequately assess and monitor the amount of blood loss from R51’s wounds. This failure resulted in harm when R51 was hospitalized from [DATE] to 8/3/19 for blood [MEDICAL CONDITION] and treatment for [REDACTED]. For R84, the facility failed to identify and treat a right foot wound on a resident that was susceptible to chronic wounds and infections until it was infested with maggots on 6/24/19 requiring hospital evaluation and treatment. For R209, the facility failed to follow the resident’s plan of care to obtain a weight on 7/24/19 as per a 7/17/19 physician’s orders [REDACTED].

6/24/19 at 7:41 PM – The hospital record’s history and physical stated, .Patient is coming from a nursing home where (he/she) was found today to have maggots in (his/her) feet .(R84) has chronic wounds on her lower extremities secondary to bedbound state .

6/24/19 at 7:45 PM – The hospital record progress note stated, .Wound noted to bottom of R (right) foot, 6 cm x 3.5, red, hypergranulation tissue (excessive granulation filling a wound bed; tissue is raised) noted, area just above, yellow necrotic (dead tissue) skin flap, 14 maggots removed from this .

6/25/19 at 12:13 PM – The hospital’s infectious disease consult stated, .Maggots in wounds .Patient has had difficulties with immobility, progressive lower body/LE (lower extremity) [MEDICAL CONDITION] and stasis ulcerations (venous wounds due to abnormal veins). Chronic ulceration right plantar lateral foot and right lateral calf more recently noted. (He/she) subsequently noted maggots on (his/her) feet yesterday .Patient notes that since admission overnight 18 more maggots were removed from (R84’s) foot. (He/she) states ‘I know there are flies around, I have a fly sweater (sic) at my bedside.’ .Right foot .moderate-copious serous drainage .Assessment/Plan .Infestation, maggots .Important to keep wounds with drainage covered to prevent ongoing infestation .Additional Recommendation or Comments .admitted with progressive stasis ulcerations/maggot infestation, super infection (previous infection and develops another strain of infection on top of the first one) suspect right lower extremity/plantar foot .

9/3/19 at 8:30 AM – Findings were reviewed with E1 (NHA) and E2 (DON). The facility failed to identify and treat a right foot wound on a resident that was susceptible to chronic wounds and infections until it was infested with maggots on 6/24/19 requiring hospital evaluation and treatment

9/4/19 at 7:30 PM – Findings were reviewed during the Exit Conference with E1 (NHA), E2 (DON) and E3 (ADON).