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Date ArticleType
3/29/2018 Regulatory
G/IJ/SSQC Citation Update – Will your Skin Management Program Result in a G Level Citation?

There was a total of 52 recertification surveys completed by the Indiana State Department of Health in the month of February.  Of those, three (5.77) were found to be deficiency free.  One provider received SSQC/IJ citations for the following:

F600 (1 time) SSQC/IJ – Free from Abuse and Neglect for failure to prevent abuse by a staff member for 2 residents.  The deficient practice resulted in Resident being placed in a Broda chair as a restraint for approximately four (4) hours and another resident being tearful after medication administration by a licensed nurse. 

§483.12 -- The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.  This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident’s medical systems. 

The immediate jeopardy began when a licensed nurse placed a resident in a Broda chair, tilted back as the licensed nurse slept at the nurse’s station.  The licensed nurse forcefully administered medication to another resident. 

There were a total of 13 G level citations as follows:

F686(6 times) – Treatment/Services to Prevent/ Heal Pressure Ulcer

§483.25(B) Skin integrity and §483.25(b)(1) Pressure Ulcers

Based on the comprehensive assessment of a resident, the facility must ensure that (i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual’s clinical condition demonstrates that they were unavoidable, and (ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing. 

Based on observations, interviews, and record reviews, the following 6 providers failed to do the following:

  • The facility failed to identify, preform weekly skin assessments, accurately document and implement treatments for pressure ulcers timely for five residents.  The facility also failed to provide preventative care and follow up with an alteration in skin integrity that was later identified as unstageable pressure injury for 3 residents.
  • The facility failed to implement interventions and treatment to prevent the development and worsening of pressure ulcers resulting in two unstageable ulcers on the right buttock and coccyx for a resident.
  • The facility failed to ensure residents who readmitted with no pressure ulcers did not develop pressure related injury.  The deficient practice resulted in a resident developing an unstageable (full thickness tissue loss with base covered by eschar).
  • The facility failed to ensure the prevention of pressure injuries.  A resident developed a stage III pressure injury to the left ankle and three stage II pressure injuries to posterior left thigh.
  • The facility failed to provide the necessary treatment to prevent the development of pressure ulcers related to failure to assess and treat a new area of excoriation which resulted in the development of an unstageable ulcer and hospitalization.
  • The facility failed to ensure interventions were in place for a resident who was at an increased risk for developing pressure ulcers which resulted in a stage III pressure ulcer to the left heel. 

F689 (6 times) – Free of Accident Hazards/Supervision/Devices                 

§483.25(d)(1)(2) – Each resident receives adequate supervision and assistance devices to prevent accidents. 

Based on observations, interviews, and record reviews, the following 6 providers failed to do the following:

  • The facility failed to ensure a resident with an altered mental status was not left alone outside in the heat for an undetermined amount of time.  The deficient practice resulted in a resident being found alone in the July heat for an undetermined amount of time in the courtyard unresponsive requiring hospitalization.
  • The facility failed to provide adequate supervision and interventions to prevent falls for 2 residents.  The deficient practice resulted in a resident sustaining a fracture to her right arm with known history of recent falls.
  • The facility failed to ensure adequate supervision of a resident with known risk for falls. The deficient practice resulted in the resident sustaining a wrist fracture during a subsequent fall.
  • The facility failed to provide supervision to prevent accidents, resulting in a fall with fractures. 
  • The facility failed to provide supervision to maintain a resident’s safety while wondering which resulted in a fall with fracture that required medical intervention. 
  • The facility failed to ensure 2 staff members implemented mechanical lift transfer care resulting in a fall and fractured leg bone.  

A provider received a citation in Respiratory/Tracheostomy Care and Suctioning for Tag F695.

§483.25(i) The facility must ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents’ goals and preferences. 

The facility failed to keep respiratory equipment in working condition.  The deficiency resulted in hospitalization for respiratory failure for a resident.  The resident indicated that there were missing pieces to her CPAP machine, so she had not been wearing it.  The resident indicated that the pieces had been missing for a while.  The machine was not the resident’s personal equipment, however supplied by the facility. 

Please direct questions to ldavenport@ihca.org.