Failure to Provide and Document Required ADL Assistance
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for several dependent residents, specifically in the areas of oral hygiene, nail care, and scheduled showers. One resident with moderate cognitive impairment and a self-care deficit was observed multiple times with a dirty upper denture and long fingernails with black debris. This resident reported not receiving assistance with denture care or oral hygiene due to missing supplies and lack of staff support, and was unable to locate a denture cup or brush. Staff interviews confirmed that oral hygiene was not provided as required, and nail care was either not offered or not documented as refused, despite visible buildup under the nails. Additionally, the same resident, along with two others, did not consistently receive scheduled showers. Documentation for showers was incomplete or missing, and staff interviews revealed that showers were often missed due to staffing shortages or lack of communication. Residents reported missing scheduled showers, with one stating that he was told he would not receive a shower due to insufficient staff, and another confirming that missed showers were not replaced with bed baths. Staff did not consistently document refusals or missed care, and did not always notify nursing leadership when showers were not provided as scheduled. The affected residents had significant physical or cognitive impairments, including quadriplegia and diabetes, requiring varying levels of assistance with ADLs. Observations and interviews indicated that the lack of assistance and documentation was a recurring issue, particularly on weekends or during periods of short staffing. The facility's failure to provide and document required ADL care, including oral hygiene, nail care, and showers, resulted in unmet care needs for multiple dependent residents.