Failure to Provide Timely ADL Assistance for Personal Grooming
Penalty
Summary
A deficiency occurred when a resident with diabetes mellitus type 2, Alzheimer's Disease, and seizures did not receive necessary assistance with activities of daily living (ADL), specifically personal grooming and hygiene. Over several days, the resident was observed with elongated fingernails and visible brown debris under the nails. The resident, who primarily spoke Creole and had moderately impaired cognitive function, was able to communicate preferences and did not refuse care. Despite being assigned to the resident, the CNA had never provided fingernail care, and there was no documentation of care refusals in the medical record or progress notes. Staff interviews revealed that both CNAs and activities personnel were responsible for providing fingernail care, and that care should be provided as needed, regardless of the schedule, especially if nails were long or dirty. The resident's care plan indicated a need for assistance with dressing, hygiene, and bathing due to weakness, cognition, and impaired communication. Facility policy required ADL care to maintain the highest practicable level of function. However, the necessary assistance with fingernail care was not provided, and there was no evidence of documented refusals or attempts to address the resident's needs as outlined in the care plan.