The deception centered on Resident #150, whose wound had deteriorated into what a nursing assistant described as "a large, open wound that was necrotic and had a foul odor."
Licensed Practical Nurse #376 documented the resident's condition during a head-to-toe assessment on October 21. But instead of recording the obvious pressure ulcer, she wrote "MASD" — moisture-associated skin damage, essentially diaper rash.
The nurse knew better.
"You and I know what his wound really is," LPN #376 texted back to her supervisor, LPN/Assistant Director of Nursing #341, who had insisted the wound be documented as MASD rather than a pressure ulcer.
During interviews with federal inspectors in November, LPN #376 admitted she "should not have documented the wound that way as she knew the area to Resident #150's coccyx was an open pressure ulcer."
The pressure to misrepresent the wound came directly from management. LPN #376 told inspectors that LPN/ADON #341 had specifically instructed her "to not document Resident #150's wound as a pressure ulcer and to continue to document the wound as MASD."
Certified Nursing Assistant #366, who cared for the resident on October 20 and 21, observed the deteriorating condition firsthand. She told inspectors the wound on the resident's buttock was large, open, and emitted a foul smell. On the morning of October 21, she noticed the resident "seemed off" and alerted LPN #376.
The resident's condition had been declining for days. LPN #376's own statement, obtained by facility administrators, revealed she had noted "a decline in the area" on October 20, though the wound had appeared stable just three days earlier on October 17.
Text messages between the nurses revealed the deliberate nature of the cover-up. When LPN #376 questioned whether they were properly documenting the wound, LPN/ADON #341 responded that it was "documented as MASD" and added that the "WNP is trying everything to not change it to pressure."
The wound nurse practitioner, it appeared, was also involved in avoiding the pressure ulcer designation.
LPN #376 later told facility administrators she had been "difficult during the interview" when Regional Registered Nurse #451 pressed for more specific details about the resident's wound condition. She provided minimal additional information beyond confirming that "the sacral wound had significantly declined."
When asked during the investigation why she had documented the wound as MASD despite knowing it was a pressure ulcer, LPN #376 gave a telling response: "I probably shouldn't have, but that was what everyone else was calling it."
The facility's own policies contradicted the staff's actions. Diplomat Healthcare's skin and wound care policy, last reviewed in September, required licensed nurses to complete weekly skin checks and mandated that the interdisciplinary team review residents with pressure injuries during resident review meetings.
The change-in-condition policy, reviewed in June, specifically required that physicians and responsible parties be notified when residents experience significant changes in physical condition.
None of these protocols appeared to be followed for Resident #150.
The misrepresentation had serious implications beyond documentation. Pressure ulcers trigger specific care requirements, reporting obligations, and regulatory oversight that MASD does not. By falsely categorizing the wound, staff avoided the scrutiny and care protocols designed to prevent further deterioration.
Federal inspectors classified the violation as causing "actual harm" to residents, though they noted it affected "few" residents. The deficiency fell under regulations requiring facilities to provide necessary care and services to maintain the highest practicable physical well-being of residents.
The investigation stemmed from two separate complaints filed with state health officials, suggesting the problems at Diplomat Healthcare may extend beyond this single case of documentation fraud.
Resident #150's condition ultimately required hospitalization, though the inspection report does not detail his current status or the full extent of harm caused by the delayed and inadequate care.
The case illustrates how nursing home staff can manipulate medical records to avoid regulatory consequences, potentially at the expense of resident safety and proper treatment protocols.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Diplomat Healthcare from 2025-11-25 including all violations, facility responses, and corrective action plans.