Failure to Provide Adequate ADL Assistance for Residents
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs) for two residents, specifically in the areas of bathing and eating. Resident R114, who was admitted with orthopedic aftercare needs, expressed dissatisfaction with the bathing assistance provided, stating she only received a basin of water for bed washing and had not had her hair washed since admission. The resident's care plan lacked specific interventions for her bathing preferences and needs, and documentation showed no record of showers or bathing until over a month after her admission. A nurse aide was unaware of the resident's specific assistance needs and did not provide hair washing, assuming the family handled hair care. Resident R78, admitted with conditions including cerebrovascular accident and dysphagia, required total assistance with eating due to shoulder and hand fractures. Despite a physician's order for 1:1 feeding assistance, observations revealed that the resident's meal tray was left untouched, and he was unable to feed himself. Staff failed to provide the necessary assistance, leaving the resident to struggle with eating, resulting in him consuming only a few bites of his meal. The resident reported that the food was cold and unappealing due to the delay in assistance. Interviews with staff indicated a lack of awareness regarding the specific assistance needs of Resident R78, with a nurse aide only recently learning of the requirement for 1:1 feeding assistance. The facility's failure to adhere to care plans and physician orders for these residents resulted in unmet needs for essential daily living activities, highlighting deficiencies in the provision of care and services as required by regulations.
Plan Of Correction
1. R114 was given a shower at the time of request. Unable to retroactively resolve R78 not eating his full meal and no adverse effects were noted. 2. An initial audit was conducted to validate assistance is provided with bathing and 1:1 feeding assistance. Variances were addressed at the time of the audit and placed on the facility audit tool. 3. DON/designee will re-educate the nursing staff on providing bathing and 1:1 feeding assistance. 4. DON/Designee will conduct random audits to ensure bathing and 1:1 feeding assistance is being provided. This audit will be conducted 3 times per week for 4 weeks, then 1 time a month for 2 months. Audit findings will be addressed and submitted to the Quality Assurance Performance Improvement Committee for further review and recommendations as needed.