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Based on observation, interview and record review the hospital failed to ensure 1 of 1 RN (Registered Nurse) evaluated and ensured care was provided for 1 of 1 total care, dependent patient (Patient #1). Patient #1 was found by the surveyor during observation rounds on 01/27/12 incontinent of urine and feces. RN #3 further failed to ensure Patient #1 was fed the noon meal and/or provided a snack.

Findings included:

On 01/27/12 at 4:05 PM observation rounds were conducted with Staff #2 on the nursing unit Patient #1 resided on. The following was observed:

Patient #1 was lying in the bed with oxygen on. Patient #1 was awake and said hello. The surveyor observed Patient #1's lunch tray sitting on the over the bed table. The table and lunch tray were not within the reach of Patient #1. The lunch tray had not been disturbed. The applesauce, lasagna, mixed vegetables, bread stick and tea had not been touched. Patient #1 was asked by the surveyor if she ate. The patient said she did not think so.

Staff #3 was asked by the surveyor to check the patient for incontinence. Staff #3 and #4 rolled Patient #1 on her right side. Patient #1 was incontinent of a large amount of feces. The pad under the patient was wet with brown/yellow rings. Patient #1's bottom was dark red with creases and indentations on Patient #1's coccyx from the pad. The pressure sore on Patient #1's bottom appeared open. The surveyor asked Staff #3 if the pressure ulcer was open. Staff #3 stated she did not know, wound care saw the patient. Patient #1's perineal area was red and excoriated at the time of this observation. Staff #3 was asked when Patient #1 was changed. Staff #3 said sometime in the morning. Staff #3 stated she did not have a technician and there were extenuating circumstances. Staff #3 was asked why Patient #1 was not fed her lunch. Staff #3 stated the patient was asleep. Staff #3 also stated she was busy with her two other patients. Staff #3 asked Patient #1 if she needed anything. Patient #1 said she wanted coffee.

The history and physical dated 01/24/12 timed at 16:55 PM reflected, Patient #1 "admitted 01/23/12 for cough, congestion, right lobar pneumonia, nursing home-acquired...history of cancer of uterus and had surgery and treatment, a history of diabetes, hypertension...denies any chest pain...patient being started on Zosyn...I did call the nursing home...the patient is on conservative therapy the next 2 to 3 days with antibiotics, hydration, monitored, other medications and diabetes..."

The All Flowsheet dated 01/23/12 timed at 20:58 reflected, "Present on admission (Pressure Ulcer Only)...Stage I medial coccyx...at 21:01 PM present on admission (Pressure Ulcer Only)...suspected deep tissue injury...left heel....at 21:02 PM present on admission (Pressure Ulcer Only)...Stage II right heel..."

The physician's orders dated 01/23/12 timed at 21:53 PM reflected, "Turn and reposition patient...elevate heels above bed surface...off load heels with pillows lengthwise on all surfaces...."

The Wound Care Note dated 01/25/12 timed at 13:47 PM reflected, "Patient opens eyes but does not verbalize. Assessed bilateral heels which revealed suspected deep tissue ulcers with left being a very dark red blister and right heel is open with callous periwound. Coccyx is red, denuded and gluteal crease is purple...suspect deep tissue injury on coccyx...patient is unable to turn on her own and is currently incontinent of stool...patient needs frequent re-positioning and heels need to be floated at all times..."

The All Flowsheet Data dated 01/27/12 timed at 09:36 AM under the section entitled "intake (%)" reflected, "Less than 10. Patient unable to wake up for breakfast...at 10:50 AM, 12:24 PM, 12:26 PM, 13:30 PM, 14:40 PM, 15:12 PM, 16:30 PM...17:49 PM." No food intake was documented. Nor was any documentation found indicating staff attempted to feed patient and/or provide Patient #1 a snack.

The All Flowsheet Data dated 01/27/12 under the section entitled, "Intake (%) timed at 18:19 PM reflected, "Total feed."

The All Flowsheet Data dated 01/27/12 under the section entitled, "Skin Interventions,Hygiene Care" timed at 08:15 AM reflected, "Incontinence care; linen change; perineal care..." The flowsheet data for 01/27/12 timed at 09:36 AM, 10:50 PM, 12:24 PM, 12:26 PM, 12:29 PM, 13:30 PM, 14:40 PM and 15:12 PM was left blank. No documentation was found which indicated Patient #1 was provided hygiene care until the surveyor's above observation.

On 01/27/12 at 4 :55 PM Staff #5 was asked what the staffing was for the dayshift and how many patients were on the unit. Staff #5 stated nine patients and four Registered Nurses were on duty.

On 01/27/12 at approximately 5:10 PM Staff #3 was interviewed. Staff #3 stated she had a very busy day. Staff #3 stated Patient #1 was asleep the entire day.

The policy entitled, "Assessment and Reassessment of Patients" with an effective date of 01/01/12 reflected, "Information used in the patient assessment may include...age, biophysical, psychological, cognitive and communicative, nutritional, functional...data collected is used to identify and prioritize the needs of the patient, and make care/treatment decisions based on the patient's desire for treatment and the patient's response to any previous treatment..."