Failure to Assist Dependent Resident with Bedtime Clothing Change
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living for a dependent resident who was unable to change her own clothes. Despite facility policy requiring residents' clothing to be changed daily and when soiled, staff did not assist the resident in changing from her day clothes into pajamas or gowns before bed. Multiple observations and interviews confirmed that the resident frequently slept in her regular clothes, and staff did not offer or provide help to change her into bed clothes, even though she expressed a preference for sleeping in pajamas and had them available. The issue was reported to facility administration multiple times but was not addressed. The resident involved had a history of Type 2 Diabetes Mellitus, hypertension, end-stage renal disease on dialysis, impaired mobility, and required assistance with all activities of daily living. Her cognitive assessment indicated severe deficits, and she was dependent on staff for personal hygiene and dressing. Staff interviews confirmed awareness of the requirement to change residents into bed clothes, yet the resident was repeatedly left in her day clothes overnight, contrary to both her wishes and facility policy.