Failure to Provide Scheduled ADL Care for Resident
Penalty
Summary
The facility failed to ensure that a resident who is unable to carry out activities of daily living (ADLs) received the necessary services to maintain good grooming and personal hygiene. This deficiency was identified for one of two residents reviewed for ADLs, specifically Resident 23. The facility's policy on ADLs emphasizes maintaining as much independence as possible in daily activities, including hygiene. However, Resident 23, who has diagnoses of spinal stenosis, repeated falls, and muscle weakness, reported not receiving a shower for over two weeks at times, and specifically not for eight days recently. Resident 23's clinical record indicated a preferred shower schedule of Wednesdays and Saturdays during the 2-10 shift, but records showed missed showers on multiple dates in January, February, March, and April 2025. The Nursing Home Administrator noted that Resident 23 sometimes refused to get out of bed for showers, but there was no documentation of such refusals or any reapproach attempts in the clinical record. The Director of Nursing stated that staff are expected to document refusals and reapproach residents later, which was not done in this case.
Plan Of Correction
1. Facility cannot edit old documentation errors. 2. Facility will audit ADL care for dependent residents with regards to hygiene and bathing to identify any baseline opportunities for missed documentation or incorrect documentation. 3. DON or designee will provide education to the nursing staff on reviewing the ADL coding report prior to end of shift to ensure completion and accuracy of hygiene and bathing (showers) and address concerns prior to end of shift. 4. DON or designee will provide education to nursing staff regarding ADL coding and accuracy of coding in regard to hygiene and bathing. 5. Nursing staff will run an ADL coding report prior to end of all shifts with regards to bathing and hygiene (showers) to ensure showers are given and if resident is refusing what other alternatives were offered (bed bath). 6. An audit will be conducted by DON or designee three times weekly x 4 weeks, then two times monthly x 2 months for ADL coding for dependent residents with regards to hygiene and bathing. 7. Results of the audit will be taken to the QAPI committee for review of findings and further interventions if warranted.