Parkwood Skilled Nursing: Wound Care Documentation Failures - MO
That gap mattered. By the time the facility's Wound Nurse learned the resident had a dark, soft area on their right heel, weeks had already passed. She found out not through documentation or a scheduled assessment, but because a staff member happened to mention it on September 17, 2025.
The Wound Nurse told inspectors she could not say with certainty whether the resident came into Parkwood with that wound or developed it there. A skin assessment was never performed on admission. There was nothing to compare against.
What she found on September 17 was a deep tissue injury, the kind that looks like a dark bruise but signals damage to the layers of skin underneath. The resident's care plan called for daily treatment: removal of dead tissue applied to the wound bed, covered with silver alginate and secured with a foam dressing. Inspectors found no documentation showing those treatments were consistently completed or that anyone recorded the wound's condition week to week.
Then, on October 11, another staff member told the Wound Nurse the heel had opened. She consulted the Wound Nurse Practitioner. The resident was not actually seen by the Wound Nurse Practitioner until October 16, five days later.
A skin assessment completed on October 6 was flagged by the Wound Nurse herself as inaccurate. She told inspectors she expected staff to describe skin conditions accurately and note their location. That hadn't happened.
The Wound Nurse, who also carries Nurse Manager duties, was direct about the limits of her own capacity. It would be impossible, she said, for her to complete every skin assessment on every resident every week. Under the facility's own system, she was not responsible for weekly wound documentation unless the resident had been seen by the Wound Nurse Practitioner. That visit didn't happen until nearly a month after the wound was first discovered.
Nurse Manager A, interviewed the morning of the inspection, confirmed that the resident's admission had not been completed properly. The Braden score, a standard tool for assessing a patient's risk of developing pressure injuries, was never done. The head-to-toe assessment that should have been completed on arrival was not done either.
LPN B laid out what the process was supposed to look like: admission assessment on arrival, weekly skin assessments signed off on the treatment administration record, a skin assessment data form completed each week regardless of whether there were problems, and a progress note whenever a wound's condition changed. If something looked wrong, the Wound Nurse was to be called. That chain of accountability, described clearly by the nurse in the interview, had not functioned for this resident.
The Director of Nursing told inspectors she expected weekly skin assessments to be completed on time and accurately, and that any resident with a wound should have a progress note each week tracking whether it was improving or getting worse. The record for this resident had neither.
What the inspection found, in the end, was a system where everyone could describe the correct procedure and no one had followed it. The admitting nurse did not complete the admission. The charge nurses did not complete the weekly assessments. The skin data forms were not filled out. The one assessment that was completed was wrong. And the Wound Nurse, stretched across two roles, learned about a deepening heel injury the same way anyone might: someone mentioned it in passing.
The resident's right heel had gone from whatever condition it was in on arrival, unknown because no one checked, to a deep tissue injury, to an open wound, across a span of weeks in which the formal documentation trail was nearly empty.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Parkwood Skilled Nursing and Rehabilitation Center from 2025-11-06 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 22, 2026 · Our methodology
PARKWOOD SKILLED NURSING AND REHABILITATION CENTER in MARYLAND HEIGHTS, MO was cited for violations during a health inspection on November 6, 2025.
By the time the facility's Wound Nurse learned the resident had a dark, soft area on their right heel, weeks had already passed.
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.