SPOKANE, WA - Touchmark on South Hill Nursing received citations from state inspectors following an August 2024 complaint investigation that found significant deficiencies in pressure injury prevention and wound care management affecting multiple residents.
Critical Wound Assessment and Documentation Failures
The facility failed to consistently assess, monitor and evaluate wounds for three residents reviewed during the inspection, according to the Centers for Medicare & Medicaid Services report. Inspectors found inadequate wound measurements, missing documentation details, and failure to implement individualized skin protection interventions.
Resident 4 arrived at the facility in February 2024 with existing pressure injuries but developed additional wounds during their stay. The resident had unstageable pressure injuries to both heels and Stage 3 pressure injuries to the buttock and sacrum area. Most concerning, the resident developed a urethral skin split from catheter positioning that went unaddressed despite being noted by nursing staff on February 24.
The facility's wound care documentation consistently lacked critical measurements and detailed descriptions required for proper monitoring. Multiple skin assessments showed wounds without documented measurements, making it impossible to track healing progress or deterioration.
Medical Device-Related Injuries and Poor Catheter Management
A particularly serious issue involved medical device-related injuries. Resident 4 developed a 1.5-centimeter urethral skin split due to improper catheter positioning and securement. Despite nurses observing "mild redness around the urethral meatus" on February 24, the catheter remained in place for several more days.
Proper catheter management requires securing the device to prevent movement and tissue damage. The urethra's delicate tissue can quickly develop pressure injuries when catheters pull or create friction against the skin. This type of injury can lead to painful complications and potential infections if not promptly addressed.
The resident's spouse reported that their family member "spent majority of their time in bed on their back instead of on their side," indicating inadequate repositioning protocols that contributed to pressure injury development.
Inadequate Prevention Protocols for High-Risk Residents
Resident 5 entered the facility in June 2024 without pressure injuries but developed a Stage 1 pressure injury to the coccyx area within weeks. The resident had undergone recent cervical spine surgery and wore a neck collar, limiting their mobility and increasing pressure injury risk.
The resident specifically told staff they thought they were "developing a pressure injury from lying on their back all the time." This clear indicator of inadequate repositioning protocols demonstrates how preventable pressure injuries can develop when proper turning schedules aren't maintained.
Resident 6 similarly arrived without pressure injuries in May 2024 but developed a Stage 1 pressure injury to the right buttock by early June. This resident wore a back brace for thoracic compression fractures, creating additional pressure points that required specialized attention.
Understanding Pressure Injury Severity and Consequences
Pressure injuries range from Stage 1 (surface redness) to Stage 4 (deep tissue damage exposing bone or muscle). Stage 3 injuries, like those affecting Resident 4, involve full-thickness skin loss extending into subcutaneous fat tissue. These wounds can take months to heal and carry significant infection risks.
Unstageable pressure injuries occur when dead tissue obscures the wound's true depth, making treatment planning difficult. These wounds often require surgical debridement and specialized care from wound specialists.
The facility's own policies required weekly skin assessments with detailed documentation including "wound measurements, wound site, wound type, wound status, drainage, status of surrounding tissue, signs of infection, and pain identified." However, inspectors found multiple assessments lacking these critical details.
Required Standards and Best Practices
Federal nursing home regulations mandate that facilities prevent avoidable pressure injuries and provide appropriate treatment when they occur. This includes comprehensive risk assessments, individualized prevention plans, proper nutrition support, and regular repositioning schedules.
Industry best practices call for repositioning immobile residents every two hours, using pressure-relieving devices like specialized mattresses and cushions, maintaining proper skin hygiene, and ensuring adequate protein intake for tissue health. The facility's policies outlined these requirements but implementation appeared inconsistent.
Additional Issues Identified
Beyond pressure injury management, the inspection revealed broader care planning deficiencies. The facility failed to update care plans when residents' conditions changed, didn't consistently implement ordered interventions like pressure-relief wheelchair cushions, and had gaps in communication between nursing staff and wound care specialists.
Nursing staff acknowledged during interviews that pressure injuries develop from "unrelieved pressure for an extended period" and require "proper hygiene and a turning or repositioning schedule." However, the documented care showed these principles weren't consistently applied.
The wound care nurse stated that different types of skin damage require different treatments, noting "an abrasion would be treated differently than a stage 2 pressure injury," highlighting the importance of accurate initial assessments and ongoing monitoring.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Touchmark On South Hill Nursing from 2024-08-22 including all violations, facility responses, and corrective action plans.
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