Failure to Provide Adequate ADL Assistance: Bathing, Nail, and Oral Care
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs), specifically bathing, nail care, and oral care, for three dependent residents. Observations and interviews revealed that these residents, all of whom were dependent on staff for personal hygiene due to conditions such as multiple sclerosis, stroke, and dementia, were not receiving necessary care. For example, one resident was observed multiple times with food particles in their teeth, long and dirty fingernails, and untrimmed toenails. Staff interviews confirmed that nail care was not being completed due to staffing changes, and oral care was not consistently provided after meals. Another resident, also dependent on staff for all ADLs, was observed with long, dirty fingernails and visible scratch marks on their skin from itching. This resident reported feeling itchy and expressed a preference for bathing, but records showed infrequent showers and refusals of bed baths. Staff acknowledged that oral care and bathing had not been completed as required, and documentation for nail care was lacking for an extended period. A third resident with severe cognitive impairment and dependence on staff for personal hygiene was found with long, dry, and dirty fingernails and toenails, as well as food stuck in their dentures. The resident's representative reported that the resident often appeared disheveled and that denture care was not performed regularly. Staff interviews indicated that while personal care tasks were assigned, there was no documentation for completion of nail care or other hygiene-related tasks, and staffing shortages had impacted the ability to provide these services.