The substitution continued for months at Allure Of The Quad Cities without anyone noticing the prescribed steroid cream had run out in May.
When federal inspectors arrived September 19, they asked the nurse to show them the triamcinolone cream she was supposed to apply daily to the resident's right leg wound. She searched the medication cart, then the treatment cart.
"There was none in stock," she told inspectors. "She applied the antifungal cream instead."
The nurse, identified as V9 in the inspection report, could not recall when she had last used the actual prescribed medication. She said the triamcinolone should be in the medication cart and applied every day to his right leg for cellulitis.
When she checked pharmacy orders, the last time the cream was ordered was May 2025.
At 11:10 AM, the nurse presented inspectors with a tube labeled "Derma Fungal, Miconazole Nitrate 2%" — medication designed to treat athlete's foot, jock itch and ringworm.
The resident had been admitted with multiple diagnoses including type 2 diabetes, a chronic ulcer on his right lower leg, and cellulitis. His treatment record showed a specific order for triamcinolone acetonide external cream 0.1% to be applied topically to the right leg's open area every day shift for wound care.
The nurse acknowledged the triamcinolone cream was being used to prevent infection. The antifungal cream she was using instead "was not the same thing."
The Director of Nursing confirmed the problem when inspectors spoke with her thirteen minutes later.
"The triamcinolone cream comes from the pharmacy and is a steroid cream," she said. "The anti-fungal cream would not be effective for R2's wound care."
She said nurses should be reordering medications through the computer system. More troubling, she noted that nurses should not have been documenting the cream as applied if it wasn't available.
"The antifungal cream is not an appropriate substitution for triamcinolone cream," the director said. Staff should have contacted the pharmacy, and if they couldn't get the medication, "they should have let us know and not just use something random."
Pharmacy records showed the facility's last reorder of the resident's triamcinolone cream was June 17 — two months before the inspection.
The facility's medication administration policy requires that medications be given "as ordered by the physician and in accordance with professional standards of practice." The policy specifically mandates following the "six rights of medication administration," including administering the "right drug."
Staff are required to compare the medication source with the administration record to verify the resident's name, medication name, form, dose, route, and timing.
The nurse's substitution violated multiple aspects of this protocol. She gave the wrong medication for the wrong condition while documenting that she had followed the physician's order.
Triamcinolone acetonide is a topical corticosteroid used to reduce inflammation and promote healing in chronic wounds, particularly important for diabetic patients whose ulcers heal slowly and are prone to infection. Miconazole nitrate treats fungal infections on the skin.
Using an antifungal medication on a chronic diabetic ulcer not only fails to address the inflammation and healing needs but could delay proper treatment of a serious condition.
The resident's treatment administration record continued to show daily applications of triamcinolone throughout the period when none was available, creating a false medical record of care that was never provided.
Federal inspectors found the facility failed to ensure the resident's medication was available, violating regulations requiring nursing homes to provide appropriate pharmaceutical services to meet each resident's needs.
The inspection classified this as causing minimal harm or potential for actual harm, affecting few residents. However, for the diabetic resident with a chronic leg ulcer and cellulitis, months of receiving the wrong topical treatment while his medical record showed appropriate care represented a significant breakdown in basic medication management.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Allure of the Quad Cities from 2025-09-19 including all violations, facility responses, and corrective action plans.