Failure to Provide Adequate ADL Care and Activities Due to Insufficient Staffing
Penalty
Summary
Surveyors identified that multiple residents with significant cognitive and physical impairments did not receive appropriate assistance with activities of daily living (ADLs), personal hygiene, and engagement in meaningful activities. Observations revealed that several residents were left in unkempt conditions, such as uncombed hair, wrinkled or soiled clothing, and food debris on their faces and wheelchairs. Residents were also left unattended in the activity room for extended periods without staff interaction or access to scheduled activities, and some went without drinks or snacks between meals. These findings were corroborated by staff interviews, which consistently reported insufficient staffing levels to meet residents' care needs, particularly for those requiring two-person assistance for transfers and lifts. The report details that residents with diagnoses including dementia, Alzheimer's disease, depression, anxiety, and other chronic conditions were dependent on staff for all or most ADLs. Care plans for these residents specified individualized needs, such as wearing a bra daily, having hair combed, participating in preferred activities, and receiving one-on-one visits. Despite these directives, residents were observed without proper grooming, in soiled or stained clothing, and not engaged in activities tailored to their preferences. Staff interviews confirmed that due to inadequate staffing, morning personal hygiene was often neglected, and activities were not consistently provided or updated to reflect residents' interests and needs. Activity staff were not always present, and when absent, there was no effective coverage or communication to ensure residents' activity needs were met. The activity calendar was described as outdated and rarely changed, and spiritual needs for certain residents were not addressed due to lack of outreach to appropriate clergy. Administrative staff acknowledged that not all activities met residents' needs and that staffing levels were a point of contention, with some administrators believing staffing was sufficient while direct care staff disagreed. Facility policy required sufficient nursing staff to maintain residents' highest practicable well-being, but observations and staff statements indicated this standard was not met.