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Based on observation, staff interview, and record review, the facility failed to provide services to prevent the worsening of a pressure ulcer for 1 (#3) of 3 patients sampled.

Findings:

Record review for Patient #3 revealed that on 09/28/13 she was admitted to the hospital for abdominal pain and underwent abdominal surgery on 10/08/2013. She was discharged on 10/10/2013.

Review of the Emergency Department Nursing Assessment: 09/29/2013 revealed: Skin Information: redness/stage I decubitus ulcer to cocci. Skin Abnormality Present: Yes

Review of the Nursing Assessment dated 09/29/2013 9:35 AM revealed "assessment coccyx is red".

Review of the Nursing Assessment on 10/08/2013 at 8:00 AM revealed an integumentary Note: Decubitus ulcer stage 2 sacrum.

Review of the Nursing Assessment dated 10/09/2013 rvealed Stage 2 decubitus ulcer covered with Duoderm

10/10/2013 date of discharge
Discharge summary revealed a discharge diagnosis of early sacral decubitus

10/11/2013 the patient presented to the ED with a complaint of bedsore right buttocks, discharged yesterday.

10/11/2013 Nursing assessment decubitus ulcer on her coccyx/sacral area. Dark colored tissue noted to the center of the wound.

10/11/2013 Admission Diagnosis: Sacral decubitus stage II.

Based on record interviews and record reviews, the facility failed to ensure the patients' discharge plan included the coordination of healthcare resources based on the post hospital patient needs for 1 of 3 sampled patients with pressure wounds.

Findings:
Record review for Patient #3 revealed that on 09/28/13 she was admitted to the hospital for abdominal pain, underwent abdominal surgery on 10/08/2013 and was discharged on 10/10/2013.
A review of the nursing notes revealed:
On 10/08/2013 at 8:00 AM an integumentary Note: Decubitus ulcer stage 2 sacrum.
Integumentary Assessments conducted on 10/09/2013 at 21:00 showed a stage 2 decubitus ulcer covered with duoderm.
10/10/2013 Discharge summary revealed a discharge diagnosis of early sacral decubitus
A review of the case management notes dated 10/09/2013 revealed that home health orders were for physical therapy. (No wound care orders)
A review of the case management notes on 10/10/2013 revealed the assisted living facility was called and accepted the patient back. The case management note also revealed the clinical, orders and 1823 were faxed.
A review of the 1823 signed by the physician dated 10/09/2013 revealed a Health Assessment: Any stage 2,3, or 4 pressure sores? N (No)
In your professional opinion, can this individual ' s needs be met in an assisted living facility, which is not a medical, nursing or psychiatric facility? Yes
The patient was discharged on 10/10/2013 and readmitted on 10/11/2013 with a Stage II pressure ulcer.
An interview with the case manager on 11/21/2013 at 2:36 revealed discharge planning starts on first day of admission to get a baseline to identify needs and watch development during treatment. The Assisted Living Facility can take wounds if licensed and have nurses. It would depend on the license. Some have nurses and some don ' t. Will call and see if they (the facility) accepts a patient. The 1823 is filled out by the physician. She stated she does not check the license of the Assisted Living Facility.
The Director of Quality, interviewed at 2:56 PM on 11/22/2013, revealed the case manager uses criteria to decide is the patient goes to an ALF or SNF in co-ordination with orders from the physician.