Failure to Implement Care Plan Interventions for Hydration and ADL Care
Penalty
Summary
The facility failed to implement care plan interventions related to activities of daily living (ADL) care and hydration for one resident with moderate cognitive impairment and a diagnosis of chronic obstructive pulmonary disease (COPD). The resident was dependent on staff for ADL care and had physician orders to increase water intake, as well as care plan interventions to encourage adequate fluid intake and assist with ADLs, including nail care and hygiene. Observations revealed that the resident did not have water, a water pitcher, or a glass within reach at multiple times throughout the day. Bottled water and a gallon of water were present in the room but were out of the resident's reach. The resident's fingernails were noted to have a thick, grayish brown substance beneath each nail, indicating a lack of proper nail care as outlined in the care plan. Interviews with staff confirmed that water and fluids were not consistently provided to the resident as required by the care plan and physician orders. The LPN acknowledged that fluids were not given during the morning and was unsure of the amount consumed by the resident. The DON and Administrator both stated the importance of following care plans and ensuring hydration, but observations and staff interviews indicated that these interventions were not consistently implemented. The failure to provide accessible fluids and perform necessary ADL care, such as nail hygiene, constituted a deficiency in meeting the resident's care needs as outlined in the care plan.