Failure to Assist Resident with Personal Hygiene Needs
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living for Resident #21, who was unable to perform these tasks independently due to medical conditions including a stroke and hemiplegia. Despite being cognitively intact and having an assessed need for assistance with personal hygiene, Resident #21 did not receive the requested help with shaving and fingernail care. Observations revealed that the resident had long, broken, and jagged fingernails and several days of beard growth, despite having asked the nursing staff for assistance. Interviews with facility staff, including Certified Nursing Assistants and Licensed Practical Nurses, indicated that grooming tasks such as shaving and fingernail care were expected to be completed on shower days and as needed. However, these tasks were not performed for Resident #21, as evidenced by the resident's unshaved facial hair and untrimmed fingernails during multiple observations. The facility's policy required that such care be provided in accordance with the resident's assessed needs and personal preferences, but this was not adhered to, resulting in the deficiency.
Plan Of Correction
Plan of Correction: Approved February 7, 2025 1. Resident #21 was provided shaving and fingernail care on 1/14/2025 as per care plan. Resident #21 remains in the facility in stable condition. There were no adverse effects including alteration of skin integrity to resident #21 noted from the lack of timely ADL care. CNAs were counseled and educated by the DON/designee regarding appropriate ADL care and subsequent documentation including refusals of care if indicated. Nurse Managers and LPN/RNs will be educated by the DON or designee regarding frequent rounding to ensure that residents are provided ADL care as per the care plan and facility policy. 2. All residents have the potential to be affected by the deficient practice. Random reviews of residents will be conducted by the Unit Managers/ designees. This review will ensure that all residents have appropriate shaving and fingernail care as per the care plan. Any issues addressed will be immediately addressed. 3. Policy for Activities of Daily Living (ADL) care and support was reviewed by the Regional RN with no revisions required. Nursing staff and facility leadership will be educated by the Regional RN/ designee regarding ADL care for residents and subsequent documentation. The unit managers will conduct random daily ADL care rounds to ensure that ADL care is completed; this daily rounding will include ensuring shaving and fingernail care as per the care plan. Any issues identified will be immediately addressed. An ADL Committee will be established; this Committee will consist of IDT team members, Nursing Administrative staff, and a CNA representative. This Committee will meet bi-weekly x 3 months and review ADL audits and barriers to provision of timely ADL care- i.e. resident refusals, CNA compliance, residents with agitation during care, and other factors as indicated. The ADL Committee will address any issues identified. 4. A comprehensive weekly audit will be conducted by the Nursing Administrative staff. Five residents from each unit will be audited for a period of 12 weeks. The audit will include a review of shaving and fingernail care and frequency of care provided. The Regional RN will review these audits weekly and provide input as needed. The results of the audits will also be reviewed with the QAPI and ADL Committees for input. The QAPI and ADL Committees will then determine if further audits are needed. The Director of Nursing is the responsible party.