Failure to Provide Timely Assistance with Activities of Daily Living
Penalty
Summary
The facility failed to provide timely assistance with activities of daily living (ADLs), specifically incontinence care and personal hygiene, to residents who were unable to perform these tasks independently. For one resident with a history of left femur fracture and moderately impaired cognition, multiple observations and interviews revealed that the resident experienced long wait times for incontinence care, with reports of waiting over 30 minutes for assistance, particularly during overnight shifts. The resident was found in bed with the call bell out of reach and stated that care was inconsistent, with delays in receiving help with toileting, dressing, and personal hygiene. Staff interviews confirmed that the resident had not received morning care by late morning, and aides reported being overwhelmed by the number of residents requiring two-person assistance, which contributed to delays in care provision. Another resident, dependent on staff for all ADLs due to conditions including cerebral infarction, hemiplegia, and aphasia, was documented to have waited over 66 minutes for incontinence care after activating the call bell. The facility's own investigation confirmed the extended wait time, and the DON acknowledged that such a delay was unreasonable. The care plans for both residents indicated a need for staff assistance with incontinence care and personal hygiene, but these needs were not met in a timely manner as required by facility policy and regulatory standards. Staffing levels were identified as a contributing factor, with aides and nurses reporting high resident-to-staff ratios and increased workloads, especially during shift changes and overnight hours. Although the DON and Administrator stated that call bell response times were monitored and no concerns had been identified, direct observations, interviews, and facility records demonstrated that residents' ADL needs were not consistently addressed in a timely manner, resulting in deficiencies in the provision of necessary care and services.