Failure to Provide Necessary ADL Assistance for Personal Hygiene and Grooming
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for two residents who were unable to perform these tasks independently. One resident, a male with a history of cerebral infarction, hypertension, atrial fibrillation, and diabetes mellitus, required extensive ADL care with one staff assist and had a care plan that included nail care. Despite this, observations revealed that his fingernails were dirty with a dark brown substance, and he reported that staff had not cleaned his nails even when he requested it. Multiple staff members, including CNAs and LVNs, acknowledged the resident's dirty fingernails and recognized the importance of nail care in preventing infection, but also indicated a lack of recent in-service training or skills check-offs related to ADL or nail care. Another resident, a male with end stage renal disease, hypertension, atrial fibrillation, and coronary artery disease, was dependent on staff for ADL care. Observations showed that this resident had ashy, dry patches of skin and was seen scratching his skin, which he reported was not being moisturized by staff after bed baths. Staff interviews confirmed that aides were responsible for applying lotion as part of daily ADL care, but the resident stated this was not being done. Staff also indicated that there was no recent training or skills check-off on skin care, and the resident's care plan did not include completed ADL care instructions. Record reviews and staff interviews further revealed that there was no documentation of recent training, skills check-offs, or in-service education for staff regarding nail and skin care. The facility's own policy required nail care to prevent infection, but staff relied on prior school training rather than facility-provided competency checks. The lack of adherence to care plans and absence of ongoing staff training contributed to the residents not receiving necessary personal hygiene and grooming services.