Deficiency in Personal Hygiene Care for a Resident
Penalty
Summary
The facility failed to ensure that a resident who was unable to carry out activities of daily living received the necessary care and services to maintain good personal hygiene. Resident #90, who had severely impaired cognition and required supervision with activities such as toileting, dressing, and personal hygiene, was observed multiple times with long, greasy hair, an unshaven face, and long, ungroomed fingernails. The resident's care plan indicated a need for supervision in personal hygiene, and a physician's order specified daily showers. However, observations on several occasions revealed that these hygiene needs were not met. Interviews with staff members, including a Certified Nurse Aide (CNA), a Licensed Practical Nurse (LPN), and a Registered Nurse Unit Manager, highlighted a lack of adequate time and supervision to ensure the completion of personal hygiene tasks. The CNA acknowledged responsibility for daily personal hygiene care, including nail grooming, but cited time constraints as a barrier. The LPN and Unit Manager confirmed that CNAs were expected to provide nail care and that nurses were responsible for supervising these tasks. Despite these expectations, the resident continued to exhibit signs of neglect in personal hygiene, indicating a failure in the facility's care processes.
Plan Of Correction
Plan of Correction: Approved April 23, 2025 Corrective Actions for Residents Identified ADL care Provided for Dependent Residents. Resident #90 did not suffer ill effect from deficient practice. Residents who are dependent will be provided with ADL care every shift as evidenced by appearance will be well groomed. Nails will be trimmed and clean. Hair will be washed and without odor. Facial hair will be shaved to residents liking. Upon notification of this deficiency, Resident #90 was immediately provided nail care, shaved, and had his hair washed and groomed. Resident #90 was assessed and appeared to suffer no ill effects as a result of this deficient practice. Nurse Aide #17 was immediately reeducated regarding providing all ADL and grooming care to residents daily as ordered. Nurse Aide #17 was also provided guidance on time management to assist with completion of all tasks. LPN #18 and Nurse Manager #11 were both provided education regarding supervising Nurse Aides care to ensure all ordered cares were provided. Resident at Risk: Dependent residents can be affected by this deficient practice. The Director of Nursing conducted an audit to identify any other resident that may have been affected by this deficiency. All other residents appeared to be appropriately groomed. The facility respectfully states that while all residents had the potential to be affected by this deficiency, no other resident was found to be affected. Systemic Change: All nursing staff (CNA’s and Nurses) will be provided in-service education in regard to expected care of residents by Nurse Staff Educator/Designee. Specifically, residents who require total assistance with care. ADL level of care is listed on Resident Care profile card in EMR. The Administrator reviewed the facility’s policy on Activities of Daily Living and found it to be incompliance with all State and Federal Regulations. Education regarding the provision of daily ADL care, and grooming was provided to all nursing staff. Education regarding supervising CNAs to ensure daily grooming is provided to all residents was provided to all nurses. Monitoring of Corrective Actions: The DON has created an audit to ensure that daily grooming and ADL care is provided to all residents on a daily basis. Audits will be conducted on resident hygiene and grooming on all units daily x 2 weeks, then weekly x 2 weeks, then monthly x 3 months. Audits will be presented at QAPI meetings monthly by the DNS to determine continued need. Review of nursing staff attendance and completion of education will be monitored by Nurse Staff Educator/ADON/DNS. The DNS/Designee will be responsible for completion of this plan of correction.