Failure to Provide Timely ADL Assistance and Hygiene for Dependent Residents
Penalty
Summary
The facility failed to provide timely and adequate assistance with activities of daily living (ADL) for two residents who required support. One resident, with a history of dementia, depression, anxiety, diabetes, chronic kidney disease, arthritis, and blindness in one eye, was observed multiple times over several days wearing the same dress and exhibiting signs of poor hygiene, such as scratching her face and emitting a strong odor. Documentation showed that she had not received a shower or bed bath for over ten days, despite her care plan indicating a need for staff oversight due to cognitive deficits and a tendency to refuse care. The care plan and progress notes did not reflect any updated or alternative interventions to address her refusals or preferences, and staff did not attempt different approaches as outlined in facility policy. Another resident, who was dependent on staff for all ADLs due to confusion, tube feeding, diabetes, dementia, stroke, and hemiplegia, was observed at a care conference and later in her room with uncombed hair and dirty fingernails. Despite being prepared for a care conference, her grooming needs were not met, as evidenced by her appearance and the presence of black debris under her nails. The facility's ADL policy required appropriate support and assistance with hygiene, including bathing, dressing, grooming, and oral care, for residents unable to perform these tasks independently. The observations and record reviews demonstrated that the facility did not consistently provide necessary ADL care, such as bathing, nail care, and hair care, for residents who were dependent or required oversight. The lack of timely and individualized interventions, as well as failure to update care plans and follow facility policy for residents who resist care, contributed to the deficiency in maintaining residents' hygiene and grooming.
Plan Of Correction
Element One: Resident #52 had her clothes changed and shower schedule was changed to 1st shift. Resident #139 had her fingernails cleaned and hair combed per her preference. Element Two: Audit completed of all Residents to ensure fingernails are clean and hair is combed per Resident preferences. Audit completed of Residents who refused showers to ensure alternative was offered and care planned. Element Three: Administrator/Designee completed education with the IDT members who conduct room rounds to ensure Residents fingernails are clean, hair is combed per resident preference and resident is not wearing the same clothing as previous day. Director of Nursing/Designee completed education with the nursing staff to ensure residents who refuse showers are offered an alternative and documented. Director of Nursing/Designee completed education with the nursing staff in regards to ensuring fingernails are clean, clothing has been changed daily and hair is combed per resident preference. Any staff not educated by May 20, 2025 will be educated on their next scheduled shift. Element Four: Nurse Manager/Designee will complete random weekly audits X4 weeks of residents to ensure Residents are dressed appropriately, fingernails are clean and hair is combed, with findings submitted to the Director of Nursing who will report findings to QAPI for review and recommendations. Element Five: The Director of Nursing is responsible for maintaining compliance.