Failure to Provide Adequate ADL Assistance Including Bathing, Nail, and Oral Care
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs), including bathing, nail care, and oral care, for three residents who required such support. One resident, who was cognitively intact and required substantial to maximal assistance, reported not receiving scheduled baths and was observed wearing the same dress for over a week. Documentation showed gaps in recorded complete baths, with no refusals documented, despite the resident's care plan specifying her bathing preferences. Another resident, dependent on staff for showering and requiring assistance with personal hygiene, was repeatedly observed with dried food on his mouth and shirt, long fingernails with a brown substance underneath, and a thick white film on his teeth. Family members expressed ongoing concerns about his cleanliness, and records indicated missed showers without documentation of refusals. The care plan conference had previously noted similar issues raised by the resident's wife. A third resident, totally dependent on staff, was observed with long toenails, dirty fingernails, and poor oral hygiene, including strong mouth odor and peeling skin inside the mouth. Although oral care was supposed to be provided, it was not completed as observed. The resident's clinical record showed multiple missed showers without documentation of refusals. Staff interviews confirmed the existence of a shower schedule and expectations for nail and oral care, but also revealed inconsistencies in documentation and follow-through. The facility did not have a specific ADL policy, relying instead on a general resident rights policy.