Markley Rehab: Care Plan Gaps for Wound Patient - PA
Not the risk. Not the consequences. Not what staff were supposed to do when they found the prescribed dressings on the floor and homemade ones in their place.
Inspectors cited the facility on September 24, 2025, following a complaint investigation. The deficiency, tagged under federal care planning requirements, was classified as minimal harm or potential for actual harm and described as affecting few residents.
The resident's wounds were documented as involving both lower extremities, specifically the heels and great toes. The care plan, initiated August 25, 2025, identified a serious cluster of underlying conditions: cardiovascular disease, edema, a history of skin breakdown, impaired sensory perception, neuropathy, and vasculitis. These are not minor complications. Neuropathy and vasculitis together can mask the severity of a wound while simultaneously making it harder to heal. A wound that doesn't hurt may still be getting worse.
Despite that, when inspectors reviewed the care plan, they found it failed to include any interventions addressing what to do about a resident who was purchasing their own treatment supplies and applying them without clinical oversight.
What inspectors found on the unit told a more complicated story than any care plan entry. The resident's toe dressings were off entirely during the inspection. A wound note from September 10, 2025, documented a bedside examination that included the Director of Nursing, the Assistant Director of Nursing, unit managers, and a staff nurse. That's a significant gathering of clinical leadership for a single resident's wound review. What they found was a resident who described ordering ABD pads, tape, and foam dressings and putting them on themselves.
The resident had refused multiple prescribed treatments, citing burning sensations. Dakin's solution, gauze, wound gel, and calcium alginate were all declined. The current prescribed treatment at the time of the wound note was Xeroform, a petroleum-based gauze that is gentler on tissue than some alternatives.
There was a disagreement on the record. Staff told inspectors the resident had refused treatment changes. The resident denied that account.
That dispute is exactly the kind of thing a care plan is supposed to resolve, or at least document. When a resident and staff give conflicting accounts of what happened in a treatment session, there should be a documented protocol, a trail of what was offered, what was refused, what was observed. Without it, the clinical picture becomes impossible to reconstruct, and the next shift starts from scratch.
The resident was also continuing to use their heels to self-propel their wheelchair, a practice the primary care physician had specifically recommended against. Leg lift attachments for the wheelchair had been recommended. The resident was not using them. Compression therapy was inconsistent. Heel lift boots had been declined.
Each of these decisions, whether the resident's right to make them or not, carried consequences for wounds on the very body parts doing the work of moving the wheelchair across the floor.
A care plan is not a punishment document. It is not meant to override a resident's choices. But it is supposed to account for reality, including the reality that a resident with open wounds on their heels is self-propelling a wheelchair, refusing prescribed cleansing agents, and applying dressings bought outside the facility. The care plan at Markley, as of the inspection, did not account for any of that.
What it left behind was a gap between what staff knew was happening and what the clinical record reflected. The Director of Nursing was in that September 10 room. The Assistant Director of Nursing was there. Unit managers were there. A staff nurse was there. They all saw a resident with homemade dressings and wounds that were difficult to assess because the prescribed treatments kept coming off.
And then the care plan went unchanged.
The resident, in the meantime, was still ordering supplies.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Markley Rehabilitation and Healthcare Center from 2025-09-24 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 13, 2026 · Our methodology
MARKLEY REHABILITATION AND HEALTHCARE CENTER in NORRISTOWN, PA was cited for violations during a health inspection on September 24, 2025.
Not what staff were supposed to do when they found the prescribed dressings on the floor and homemade ones in their place.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.