Failure to Provide Adequate ADL Support and Maintain Resident Dignity
Penalty
Summary
The facility failed to provide adequate activities of daily living (ADL) support for two residents who required staff assistance. One resident had multiple diagnoses including diabetes mellitus, morbid obesity, major depressive disorder, delusional disorder, restless leg syndrome, chronic pain, lymphedema, and chronic respiratory failure. This resident was documented as dependent on staff for bed mobility, transfers, toileting hygiene, bathing, and dressing. Observations revealed that the resident was frequently left in unsafe or undignified positions, such as having a leg hanging off the bed and being exposed from the waist down, with the incontinent brief visible from the hallway. The resident was also left without assistance to adjust the bed for safe eating and drinking, resulting in coughing episodes, and the call light was often out of reach. Staff failed to provide timely assistance with positioning, covering, and meal setup, and the bed controls were found to be nonfunctional without prompt repair. Another resident, with diagnoses including hypertension, stroke, chronic kidney disease, angina, delusional disorder, anxiety disorder, localized edema, and major depressive disorder, was also observed to have unmet ADL needs. This resident was frequently incontinent and required supervision and setup assistance with eating and toileting, as well as a scheduled toileting program. Observations showed the resident remained in bed in soiled clothing, with a strong urine odor in the room, and was left standing in only an incontinent brief while staff and visitors could see into the room. Staff failed to ensure the resident was dressed or covered, and the door was left open, compromising privacy and dignity. The care plan for this resident lacked documentation of a physician-ordered fluid restriction, despite a progress note indicating a three-liter fluid restriction was in place. The facility's policies and care plans were found to be insufficient or lacking in specificity regarding the level of staff assistance required for these residents' functional abilities. The facility failed to provide a policy for activities of daily living support when requested. Additionally, the facility's repositioning policy outlined the need for individualized care plans and consistent repositioning programs, but observations indicated these were not consistently implemented for the residents in question. These failures resulted in ongoing unmet needs for ADL support, lack of privacy, and inadequate assistance with positioning, hygiene, and meal setup.