Failure to Provide ADL and Hygiene Care for Cognitively Impaired Resident
Penalty
Summary
A deficiency was identified when a resident with severe cognitive impairment and multiple medical diagnoses, including Alzheimer's disease, dementia, and recent femur fractures, was observed with long, uneven fingernails containing a dark, unknown substance underneath. The resident, who required substantial to maximum assistance with activities of daily living (ADLs) and moderate assistance with transfers, was seen eating with their hands in the dining room, using their fingers to pick up food. Staff interviews confirmed that the resident needed cueing and assistance for all tasks, including eating and hygiene, due to significant cognitive decline. The resident was also noted to have had a recent episode involving a large bowel movement and was described as having their hands in the BM, further emphasizing the need for hand hygiene support. Despite a care plan indicating that nail care should be provided on shower days and as needed, there was no documentation in the electronic medical record regarding the completion of nail care or hand hygiene for this resident. Family concerns were also raised about the lack of nail maintenance, with reports that requests for nail trimming had not been fulfilled. Facility policy on ADL documentation did not specifically address the provision of hygiene care, and direct care staff acknowledged the issue only after it was pointed out during the survey.