Failure to Provide Timely ADL Assistance and Proper Hygiene Care
Penalty
Summary
The facility failed to provide timely and adequate assistance with activities of daily living (ADLs) for two residents. One resident with multiple diagnoses, including hemiplegia, malnutrition, and muscle weakness, required supervision or maximum assistance for most ADLs. Despite documentation in shower and bath logs indicating that fingernail care was performed, direct observation revealed that the resident's fingernails were long, yellow, and causing discomfort due to digging into the palm of a contractured hand. There was no individualized care plan addressing fingernail maintenance or shower refusals, and nursing progress notes lacked documentation of the required three attempts to offer showers per bathing day. Another resident, also with hemiplegia and additional chronic conditions such as diabetes and vascular dementia, required maximum assistance for transfers and other ADLs. The resident requested assistance to get out of bed early in the morning but was not assisted for approximately four hours due to staff being unable to locate the resident's wheelchair. The wheelchair was eventually found after a surveyor intervened. During this period, the resident expressed distress and frustration over the delay. Staff interviews confirmed communication issues regarding the location and identification of assistive devices, and documentation did not reflect adherence to facility policies for accommodating resident needs and providing necessary equipment. Facility policies required daily cleaning and trimming of fingernails, proper documentation of refusals, and ensuring assistive devices were accessible, but these were not followed in the cases observed.