Failure to Provide Required ADL Care for Dependent Residents
Penalty
Summary
The facility failed to provide necessary activities of daily living (ADL) care for two dependent residents, resulting in unmet needs for nutrition, grooming, personal, and oral hygiene. For one resident, interviews and clinical record reviews revealed that no staff provided morning care assistance, including bathing, hygiene, or incontinence care, for at least six hours. Documentation showed repeated instances where hygiene and toileting assistance were marked as 'Not Applicable,' indicating care was not provided on multiple dates and shifts. Staff interviews confirmed that assigned nurse aides did not deliver required care, often due to staff being reassigned or leaving the unit for other duties, and no one assumed responsibility for the resident's care during those times. Another resident was observed to have received morning care late in the morning, but was not provided incontinence care or transferred out of her wheelchair for nearly four hours after lunch, contrary to her individualized toileting plan. Documentation indicated that staff initialed completion of toileting tasks even though care was not provided as scheduled. The resident's care plan required assistance with transfers, hygiene, grooming, dressing, oral care, and eating, as well as a specific toileting schedule, but these interventions were not consistently implemented. The deficiencies were confirmed through interviews with staff, review of electronic documentation, and direct observation. The findings were discussed with the Nursing Home Administrator and the Director of Nursing, who were made aware of the lapses in ADL care for both residents. The report documents a pattern of missed care and inaccurate documentation, resulting in the failure to meet the residents' assessed needs for daily living assistance.
Plan Of Correction
The statements made on this plan of correction are not an admission to and do not constitute an agreement with the alleged deficiencies. To remain in compliance with all federal and state regulations, the facility has taken or will take actions set forth in the following plan of correction. 1. Residents #5 and #7 had no negative outcome from not receiving Activities of Daily Living (ADL) care. Once identified, ADL care was provided to both residents. 2. An initial audit will be conducted by the Director of Nursing/designee of facility residents who require ADL assistance to ensure completion of his/her ADL documentation for the past seven days to determine if there were residents with missed or not completed ADL care. Residents identified with missed or not completed ADL care will be assessed by a Registered Nurse and will ensure care is completed. 3. Education will be provided to facility nursing staff regarding the Nursing Policy Activities of Daily Living (ADLs) and nursing assistant shift responsibilities. 4. Audits will be conducted by the Director of Nursing/designee of ten random facility residents who require ADL assistance to ensure completion of his/her ADL documentation and care will be conducted weekly x four and then monthly x three by the facility Director of Nursing or designee(s). Corrections and/or care will be made as necessary and results of audits will be reported at the Quality Assurance Performance Improvement meetings.