Failure to Provide Required ADL Transfer Assistance
Penalty
Summary
A deficiency occurred when staff failed to provide necessary assistance with activities of daily living (ADLs), specifically transfers from bed to wheelchair, for a resident who was unable to perform these tasks independently. The resident, who was morbidly obese, had a fractured right lower leg in a cast, and required a mechanical lift with two-person assistance for transfers, reported that in the initial days after admission, staff assisted him in getting out of bed to attend activities. However, in the following weeks, the resident stated that staff frequently did not assist him out of bed despite his requests, resulting in him remaining in bed and missing several group activities he wished to attend. Multiple observations over several days confirmed that the resident remained in bed with the call light within reach and was not assisted out of bed for scheduled activities, even when he expressed a desire to participate. Interviews with Certified Nursing Assistants (CNAs) revealed that they believed the resident always refused to get up, but there was no documentation in the medical record or CNA ADL task sheets to support consistent refusals. The Activities Director and the Director of Nursing (DON) both acknowledged that the resident required significant assistance for transfers and that he had previously participated in activities when assisted, but had not been seen out of bed for activities in recent weeks. Review of the resident's medical record confirmed he was alert, oriented, and able to make his own decisions. Care plans and assessments indicated he was totally dependent on staff for transfers and required a mechanical lift with two-person assistance. Facility policy required that residents unable to perform ADLs independently receive necessary services to maintain their abilities, and that care be provided in accordance with the plan of care. Despite this, there was no evidence that staff consistently offered or provided the required assistance for transfers, nor was there documentation of refusals, leading to the resident's inability to participate in desired activities.