BATTLE MOUNTAIN, NV - State inspectors found that Battle Mountain General Hospital's nursing home failed to establish a comprehensive care plan for a resident with a significant abdominal skin tear, violating federal requirements for coordinated patient care.
Inadequate Wound Care Planning Documented
During a February 6, 2025 inspection, surveyors discovered that a resident with a large skin tear in the left abdominal fold area received treatment but lacked the required comprehensive care plan to guide ongoing management. The resident, identified as Resident #5, had been admitted with multiple conditions including a spinal compression fracture, hypertension, and gout.
According to inspection records, nursing staff initially discovered the large slit in the left abdominal fold area and applied steri-strips - adhesive wound closure strips - instead of the usual Nystatin powder treatment. However, the facility failed to develop a formal care plan addressing the wound care treatments, interventions, and healing goals required by federal regulations.
Documentation showed nursing staff monitored the wound over several days, with notes indicating the area became red and required fresh steri-strips on January 30, 2025. Staff noted that the strips were "coming off" and planned replacement before the resident's planned family visit.
Medical Significance of Care Plan Requirements
Comprehensive care plans serve as the central coordination tool for all aspects of a resident's medical care in nursing facilities. These plans must identify specific goals, interventions, and monitoring protocols for each medical condition requiring ongoing treatment.
For wound care specifically, proper care planning is essential because skin tears in elderly residents can rapidly progress to serious infections if not managed systematically. Abdominal skin folds are particularly vulnerable due to moisture retention, friction from movement, and limited air circulation that can impede healing.
The absence of a formal wound care plan creates multiple risks. Without documented goals and intervention protocols, different nursing staff may use inconsistent treatment approaches. The lack of structured monitoring guidelines can result in delayed recognition of complications such as infection, wound enlargement, or failure to heal.
Standards Violated in Care Coordination
Federal nursing home regulations require facilities to develop comprehensive care plans that address all identified medical needs. The Chief Nursing Officer acknowledged during the inspection that "the Comprehensive Care Plan was used to direct the resident's care" and confirmed the facility's expectation that nursing staff must create care plans for wounds, including specific interventions and goals.
The LPN/Long Term Care Coordinator explained that "the Comprehensive Care Plan gave nursing the whole picture of the resident and how to provide care to the resident and should have included the care and treatment of the left abdominal skin tear."
Nevada nursing practice standards further require that Licensed Practical Nurses contribute to established care plans by recording observations and conducting focused nursing assessments. The inspection found the facility failed to meet these professional standards.
Clinical Protocols for Wound Management
Proper wound care in nursing facilities follows established medical protocols that begin with thorough assessment and care plan development. Standard practice requires documentation of wound size, depth, drainage characteristics, surrounding skin condition, and healing progress indicators.
Treatment protocols typically specify cleaning procedures, dressing types and change frequency, positioning to reduce pressure, and criteria for physician notification. Monitoring schedules must include specific parameters such as signs of infection, changes in wound appearance, and resident comfort levels.
For abdominal fold skin tears specifically, care plans should address keeping the area clean and dry, preventing further trauma from clothing or movement, and ensuring adequate nutrition to support healing. The choice between topical treatments like Nystatin powder versus wound closure strips should be based on wound characteristics and documented medical rationale.
Systemic Care Coordination Failures
The violation represents broader issues with care coordination systems at the facility. When nursing staff identify new medical conditions requiring ongoing treatment, established protocols should trigger immediate care plan updates involving the interdisciplinary team.
The inspection findings suggest gaps in both clinical assessment procedures and administrative oversight systems. Staff appropriately identified and treated the wound but failed to integrate this care into the facility's formal care planning structure.
This disconnect between bedside nursing care and comprehensive care planning can compromise continuity of care, particularly during staff changes or when residents require higher levels of medical intervention.
Additional Issues Identified
The inspection narrative indicates this violation was part of a broader regulatory review, though specific details of other findings were not included in the available documentation. The violation was classified as causing "minimal harm or potential for actual harm" affecting "few" residents.
State surveyors cross-referenced this finding with other regulatory standards, suggesting the care planning deficiency may have broader implications for the facility's compliance with federal nursing home requirements.
The facility's response plan and timeline for correcting these deficiencies was not included in the available inspection documentation, though federal regulations require nursing homes to submit detailed correction plans within specified timeframes.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Battle Mountain General Hospital from 2025-02-06 including all violations, facility responses, and corrective action plans.
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