Failure to Provide Timely ADL Care and Hygiene for Dependent Residents
Penalty
Summary
The facility failed to provide timely and adequate activities of daily living (ADL) care for two dependent residents. One resident, who was cognitively intact and had multiple diagnoses including diabetes and bowel incontinence, was observed with overgrown toenails, a full and uncovered urinary catheter drainage bag containing dark yellow urine, and dried feces on his bedding and body. The resident had not been checked or changed since the previous evening, as staff reported honoring his request not to be disturbed overnight, but did not check on him at the beginning of the morning shift. The resident's care plan did not address bowel incontinence or nail care related to his diabetes diagnosis, and staff confirmed that nail care was the responsibility of licensed nurses, with no podiatrist available. Another resident, who required substantial assistance with bathing and personal hygiene and had mild cognitive impairment, was observed with visibly soiled, overgrown, and jagged fingernails. The resident's nails had dark coloring under the nail beds and were unkempt, with one thumbnail appearing sharp and jagged. The resident expressed resignation about the state of his nails when asked if he would prefer to have them cleaned and trimmed. His care plan noted a self-care performance deficit and the need for assistance with personal hygiene and oral care. Review of the facility's ADL policy indicated that residents unable to carry out ADLs should receive necessary services to maintain good nutrition, grooming, and personal and oral hygiene. However, observations and interviews revealed that these services were not consistently provided, resulting in residents being left with unmet hygiene and grooming needs.