Complaint Investigation Report

FM2 stated the previous placement had nurses 24/7 and took good care of the wound and it looked like it was not being properly cared for at the current facility. LPA Olson reviewed Home Health notes that state facility took C1 to see PCP on 10/10/22 and ordered wound care twice a week. Doctors notes indicate that there is an ankle venous ulcer with “hemosiderin staining b/l ankles L lateral malleolus with overlying dried, nearly closed venous ulcer with significant amount of debris. # of visits: 15.” A nurse specialist came and did an evaluation on C1 on 10/19/21 and set up home health to come twice a week for wound care. Notes from C1’s Physical Exam on 4/6/22 state “nursing staff (NS)…reports that (C1) chronic venous stasis wounds have been healing quickly since the procedure” C1 had an iliac stenting in March. LPA reviewed C1’s Preplacement Appraisal Information (LIC 603) dated 7/5/22 that state under health C1 has a L ankle wound and under services needed Special medical attention stated “for wound care. Need primary care’s orders as well Talked to (FM who will)…be setting appointment with Primary in S Maria ASAP till then we’ll follow (FM) direction.”

LPA Reviewed Facility documents and see a physician visit communication forms: On 3/10/22 C1 had Outpatient Surgery Procedure LPA Reviewed surgery notes which state: “Pelvic Venogram w IVUS, Left Heel Wound Debridement, and Bilateral Common and External iliac vein angioplasty and stent placement. The diagnosis is “Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity (CODE) (CMS/HCC)” “Indications for Surgery: …(C1) who over the past 5-6 years has had repeated recurrent wound on the left lateral ankle. Despite compression therapy, the wound seems to recur. A venous insufficiency ultrasound shows no evidence of axial reflux. I, therefore, was suspicious that there was a central venous compression or occlusion. We, therefore decided to perform a pelvic venogram, intravascular ultrasound and possible endovascular intervention."

On 8/13/22 C1 saw an urgent care physician. Reason for visit is Swelling on L ankle. Medication ordered or dose changed? Yes Medication name and changes: Antibiotic. New Diagnosis? No.

On 8/31/22 C1 had a Routine visit with their Neurologist. treatment/Instruction given is blank and medication ordered or dose changed said no. New diagnosis is no and were any medications discontinued? No. The doctor ordered Liver Hepatic Function panel and VALP Valproic acid blood work and scheduled a follow up appointment for 10/7/22 for EEG.

LPA and QAS interviewed Staff and Administrator who stated they followed FM directions on how to clean the wound because there were never any prescriptions or doctors’ orders until 10/10/22. Continued on 9099-C