Failure to Provide Sufficient Staff for Bathing and Grooming Assistance
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the daily bathing and grooming needs of multiple residents, as evidenced by observations, clinical record reviews, policy reviews, and interviews with staff and residents. Several residents, including those with diagnoses such as heart failure, dementia, depression, and severe obesity, did not receive the required assistance with activities of daily living (ADLs) such as bathing, hair care, and oral hygiene. Documentation revealed significant gaps between scheduled and actual baths or showers, with some residents going up to 20 days without a documented bath or shower. In several cases, there was no documentation that staff re-approached residents after refusals or that alternative care was provided. Residents with varying levels of cognitive impairment and physical dependency reported or were observed to have unmet hygiene needs. For example, one resident with intact cognition stated she only received one bath per week due to short staffing, while another with severe cognitive impairment was observed with matted hair and poor personal hygiene. Documentation for multiple residents showed missed or infrequent bathing, lack of follow-up after refusals, and incomplete records of grooming assistance. Staff interviews corroborated these findings, with CNAs and the DON acknowledging that staffing shortages and high resident acuity impacted their ability to complete necessary care tasks. The facility's own policies required sufficient staffing to ensure resident safety and well-being, as well as regular assistance with ADLs. However, the evidence showed that these policies were not consistently followed. Residents and staff reported and documented missed baths, inadequate grooming, and insufficient assistance with oral care and toileting hygiene. The lack of documentation and follow-up on missed care further demonstrated the facility's failure to meet the assessed needs of its residents.