Virgil Rehabilitation & Skilled Nursing Center

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

gathers information through a patient interview [the history] and a hands-on examination [the physical exam] to understand the patient's health, diagnose illness, and create a treatment plan) dated 6/22/2025, indicated Resident 4 had fluctuating capacity to understand and make decisions. During a review of a care plan for alteration in skin as manifested by rash/redness site to the left inner thigh initiated on 8/7/2025 listed interventions which included give ordered treatment and monitor for effectiveness. During a concurrent observation and interview of Resident 4 on 8/13/2025 at 10:38 am, Resident 4 was dressed in a floral dress, sitting at her bedside watching tv. Resident 4 observed scratching her chest, abdomen, legs, arms, palm of her hands, her flank and her back as she spoke with the surveyor. Resident 4 stated that she had had this rash for several weeks as tears started to run down her face. Resident 4 stated that she had been complaining to the facility staff about the intense itching which has affected how she interacts in the facility. She stated that she is unable to sleep, which made her feel exhausted throughout the day, making it impossible to participate in her daily activities. Resident 4 stated that she felt unheard, anxious, depressed and in a constant state of stress. Resident 4 was observed to have widespread rash of red bumps, small blisters, or scaly patches, often accompanied by tiny, wavy burrows especially on the palms of her hands and the webs of her fingers During an interview with the TN on 8/13/2025 at 12:20 pm, TN stated that Resident 4 complained of itching to her right chest as well as bilateral inner thighs. TN stated that he was not aware that Resident 4 was itchy at night because Resident 4 was mostly Spanish speaking. During an

interview with the Director of Nursing (DON), on 8/12/2025 at 4:37 pm, the DON stated that if residents are unable to sleep, they may get restless and possibly depressed. The DON stated the physician must be called if the treatment is not effective. During an interview with the Medical Director (MD), on 8/14/2025 at 4:21 pm, the MD stated that the facility staff are expected to contact the physician whenever there is a change in condition such as rashes. The MD stated that staff must report to the physician's if the ordered treatments are not effective to ensure the resident's quality of life is maintained. The MD stated that treating

the underlying cause if insomnia is paramount and must have been investigated further instead of treating a symptom. During a review of the facility's policy and procedures (P&P) titled, Change of Condition Policy, reviewed 1/2025, the P&P indicated, The facility shall notify the resident, his or her attending physician, and representative of changes in the resident's condition and/or status.The Nurse Supervisor shall notify the resident's attending physician, consistent with medical director and physician policies, when:- There is a significant change in the resident's physical, mental, or psychosocial status;- There is a need to alter the resident's treatment significantly.

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