Your facility needs to have their liaison go over, with the hospital, exactly what your facility expects in the form of instructions and orders upon the patients discharge. What your facility needs to do is check for the paperwork before you accept your resident back (through a telephone report and ask about paperwork) and if the resident comes back without the proper paper work - don't let the ambulance company take them off their stretcher, but send them right back to the hospital. It may sound harsh (it is legal)but it will only happen once, the hospital doesn't have the bed avail. to keep letting it happen.
As for the wound issue, it is too bad this still happens. I would be curious of the CNA:patient ratio at the hospital. At my hospital, since the CNA:patient ratio improved about 7 years ago, our wound care has, also. Amazing!! It is pretty standard these days for facilities to have wound nurses, if not, wound teams. And, not knowing the patient, it sounds like he has poor circulation due to his diabetes and was lucky the toe was has far as they went with the amputation. The bruises on his stomach could have been from Lovenox shots to prevent blood clots. His other wounds, though, should have not occured. But it is hard to defend or accuse not being there personally.