Failure to Provide Adequate ADL Assistance
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for three residents, leading to deficiencies in nutrition, grooming, and personal hygiene. Resident 20, who has hemiplegia, hemiparesis, aphasia, and vascular dementia, was observed during a lunch meal service where her meal tray was placed in front of her but left covered and unattended for 20 minutes before assistance was provided. Her care plan indicated she required substantial assistance with eating, which was not promptly delivered. Resident 35, diagnosed with hemiplegia, hemiparesis, aphasia, and vascular dementia, was observed with dark facial hair on her upper lip and chin, indicating a lack of grooming. Her care plan noted she was dependent on staff for personal hygiene, yet shaving was not offered as part of her ADL care until she explicitly indicated a desire to be shaved. This oversight was confirmed by the Director of Nursing, who stated that shaving should have been offered as part of her care. Resident 101, with muscle wasting, atrophy, and Alzheimer's disease, was observed with significant facial hair on her chin over several days. Her care plan highlighted a risk for decreased ability to perform ADLs, including grooming, yet shaving was not offered during her shower. The Director of Nursing acknowledged that shaving should have been included in her ADL care. These observations and interviews with staff confirmed the facility's failure to provide adequate ADL assistance to these residents.
Plan Of Correction
1. Resident 35 was offered and assisted with shaving facial hair. Resident 101 was offered and assisted with shaving facial hair. 2. A comprehensive review of current residents who are coded as maximal assist or dependent on the MDS will be conducted to ensure that they are offered to be shaved on their shower days and provided feeding assistance timely. 3. The facility will take further steps to validate the problem does not re-occur by re-educating the licensed nurses and nursing assistants on FTag 677 and nursing policy NSG200 Activities of Daily Living. 4. Compliance will be monitored by the Director of Nursing/Designee using the ADL Care audit through a review of three residents weekly x 3 weeks to monitor if shaving was offered and three residents weekly x 3 weeks for timely feeding assistance. Random Audits will then be completed monthly x 2 to monitor for timely feeding and shaving offered with ADLs. Findings will be reported to the QAA Committee to determine the need for further audits.