Failure to Provide Required ADL Assistance Including Hygiene and Nail Care
Penalty
Summary
The facility failed to provide necessary assistance with Activities of Daily Living (ADLs) for five residents who were assessed as dependent on staff for personal care. Observations and interviews revealed that residents did not receive required support with bathing, oral care, and nail care. For example, one resident with a brain injury and total dependence on staff was observed multiple times with long fingernails, dried debris around the mouth, and yellow film on the teeth, indicating a lack of oral hygiene. The Director of Nursing confirmed that oral care did not appear to have been provided. Another resident, who was dependent on staff for showers and personal hygiene, reported only receiving bed baths instead of preferred showers, and stated that their feet had not been washed for several weeks. Documentation showed this resident received only four bed baths in thirty days, with no showers or nail care provided, and no refusals documented. Staff interviews confirmed that showers and nail care should have been provided but were not. Additional residents were observed with long, dirty fingernails and toenails, and some had black debris under their nails. These residents stated they needed staff assistance for nail care, which was not documented as provided. Staff interviews indicated that nail care was expected to be performed weekly and as needed, with refusals to be documented, but this was not consistently done. In one case, documentation of nail care was unclear as to whether it referred to finger or toenails, and care plans lacked specific instructions for nail care assistance.