Aviata At Englewood

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

help.Review of the care plan initiated on 10/31/25 revealed Resident #2 had a rash/scabies. The goal was for the resident to verbalize an acceptable level of comfort from itching and follow recommended treatment for the alleviation of scabies.On 11/4/2025 at 2:50 p.m., in an interview with Resident #2 said she has been itching for about a month now. She said she was treated for scabies. It was better but she was still itching.

She said she has asked multiple staff members to see a dermatologist. She said the cream they give her does not help the itching for long. During the interview, Resident #2 was scratching her right inner forearm where a rash was observed.Review of the clinical record for Resident #3 revealed an admission date of 12/17/22. Diagnoses included Dementia, Cerebral Infarction and Osteoarthritis.Review of the Quarterly MDS with a target date of 8/22/25 revealed Resident #3's BIMS was 08 which indicated moderate cognitive impairment.Review of the progress notes revealed on 10/21/25 the APRN documented Resident #3 had an extensive ongoing rash to the hands, arms, trunk and chest that was consistent with eczema/psoriasis versus fungal infection. She documented it was not responding to treatment. Had failed Triamcinolone (corticosteroid), oral Diflucan (antifungal), over the counter antifungals, Prednisone (corticosteroid). The resident was currently on Methotrexate (used to treat severe psoriasis) and Clobetasol (topical steroid), it does itch less.Review of the care plan initiated on 10/29/25 revealed Resident #3 has a rash/scabies. The goal was to verbalize an acceptable level of comfort from itching and follow recommended treatment for the alleviation of scabies.Review of the MAR for October 2025 revealed a physician's order with a start date of 10/29/25 for, Permethrin External Cream 5% apply to head to toe topically one time only for dry, scaley skin for 1 day. Apply to head to toe topically for rash for 1 day. Wash thoroughly after 8 hours.Further review of

the clinical record revealed that on 11/3/25, Resident #3 was seen by the dermatologist. The dermatologist documented that the resident is a new patient who is being seen for a chief complaint of rash located on

the arms, face, feet, hands and trunk. The rash is flaking itchy and painful and severe in severity. The rash has been present for months. The impression was dermatitis. Discussed biopsy but unable to perform biopsy due to unable to obtain consent for a procedure from healthcare proxy. Patient will return for follow up will consider biopsy at that time. Advised caregiver to bring necessary paperwork regarding healthcare proxy.On 11/4/2025 at 3:15 p.m., in an interview the APRN said he treated the residents even when their symptoms first started. He said he still did not feel that any of the cases were scabies but he could not prove it because the skin test was not available. He said he agreed that when the first 2 residents were treated for scabies it would have been good practice for the facility to do a full skin sweep of all the residents and interview staff.On 11/4/2025 at 11:58 a.m., an interview was held with the Infection Preventionist and the Director of Nursing (DON) related to onset of rashes, documented scabies and interventions implemented to minimize the risk of spreading potential scabies.The DON said they did not do skin sweeps or isolate residents with symptoms until 10/28/25 when an investigator showed up to investigate a complaint of possible scabies in the facility. The infection preventionist said a total of 29 residents and 15 staff members were treated for scabies. 11 of the 29 residents were treated prophylactically due to being the roommate of a resident with symptoms. She said 7 residents were still symptomatic and would be retreated.

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