Failure to Provide Adequate ADL Assistance: Nail and Oral Care Deficiencies
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for three residents who were unable to perform these tasks independently. Specifically, two residents with moderate cognitive impairment and extensive ADL needs were observed to have long, unclean fingernails with visible build-up underneath. Both residents required staff assistance for personal hygiene, and their care plans and Kardexes included instructions for regular nail care. Despite these documented needs, staff interviews revealed a lack of awareness regarding the condition of the residents' fingernails, and there was confusion among CNAs and nurses about their respective responsibilities for nail care. One resident expressed discomfort and a desire to have her nails cut, while staff acknowledged the nails were overdue for care. Another resident, also with moderate cognitive impairment and physical limitations, was found to have significant white build-up on her teeth, indicating a lack of regular oral care. The resident reported that her teeth had not been brushed for approximately two weeks and expressed a desire for more consistent oral hygiene. Staff interviews confirmed that oral care was not being performed as required, and there was inconsistency in staff understanding of the procedures for documenting and escalating refusals of care. The facility's policies required daily oral care and regular nail care, but these were not consistently implemented for the affected residents. The findings were based on direct observations, resident and staff interviews, and review of medical records and care plans. The deficiencies were not attributed to resident refusal, as documentation and interviews did not indicate consistent refusals or appropriate follow-up. The lack of proper ADL assistance placed the residents at risk for poor personal hygiene and related complications, as noted in the facility's own policies and staff statements.