Failure to Provide Consistent Assistance with Activities of Daily Living
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for several dependent residents, as evidenced by direct observations, resident interviews, and record reviews. Multiple residents were found with untrimmed fingernails, facial hair, and reported not receiving help with grooming tasks such as nail trimming and shaving, despite care plans indicating the need for staff assistance. Residents expressed that staff either promised help that was not delivered or stated that staff were too busy to assist. Care plans for these residents documented self-care deficits and required staff interventions, including hands-on assistance and cueing, which were not consistently implemented. In addition to grooming deficiencies, residents reported and records confirmed delays and inconsistencies in receiving toileting care and showers. Some residents described waiting over an hour for staff to respond to call lights for toileting assistance, resulting in prolonged periods of incontinence. Documentation in the CNA Kardex revealed multiple dates where toileting care was not recorded, and residents reported not receiving showers as scheduled or preferred. Staff interviews confirmed that residents should be changed every two hours and that documentation should occur at the time of care, but this was not consistently practiced. The affected residents had significant medical histories, including dementia, hemiplegia, Parkinson’s disease, encephalopathy, spinal cord injury, morbid obesity, and chronic illnesses, all contributing to their dependence on staff for ADLs. Despite individualized care plans outlining the need for substantial or maximal assistance with hygiene, grooming, and toileting, the facility did not ensure these services were provided as required. Facility policy also mandated support for ADLs to maintain residents’ hygiene and dignity, but observations and interviews demonstrated that these standards were not met for multiple residents.