Failure to Provide Scheduled and As-Needed Hygiene and Grooming Care
Penalty
Summary
The facility failed to provide scheduled and as-needed hygiene and grooming care for three residents who were dependent on staff for activities of daily living (ADLs). For one resident with cerebral infarction and muscle weakness, observations over several days revealed long, uneven fingernails embedded with a thick dark substance, and the resident reported not receiving routine showers as scheduled. Certified Nursing Assistants (CNAs) observed the condition of the resident's nails but did not offer assistance. Review of shower and bath records showed multiple missed or undocumented bathing opportunities, and the administrator confirmed the absence of documentation for these dates. Another resident with rhabdomyolysis, osteoarthritis, and upper extremity impairment was scheduled for showers during the night shift. The resident reported that staff would attempt to provide showers in the middle of the night, which she declined due to the timing, but stated she was not refusing showers altogether. Review of shower records indicated several dates with no documentation of showers being offered or completed, and both the administrator and unit manager confirmed that lack of documentation meant the care was not provided. Staff interviews revealed issues with time management, use of agency staff unfamiliar with facility routines, and inconsistent completion of scheduled showers. A third resident, dependent on staff for transfers and toileting due to morbid obesity, lymphedema, and amputation, reported being left in a wheelchair all night without incontinence care due to short staffing and reliance on agency aides. The resident described being left soiled and unattended despite repeated requests for assistance, and this was corroborated by staff interviews. There was no documentation in the medical record regarding the incident, and staff confirmed the resident was found soiled and upset in the morning. The facility's policy required provision of necessary services to maintain hygiene and grooming for residents unable to perform ADLs independently, but this was not followed in these cases.