Failure to Provide Assistance with ADLs Including Hygiene, Bathing, and Incontinence Care
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for three residents, specifically in the areas of oral hygiene, incontinence care, bathing, and nail care. One resident, who was admitted with severe cognitive impairment and required staff assistance for all ADLs, was observed with excessively long fingernails and reported that his nails had never been cut since admission. Documentation showed that he had only received two bed baths over a six-week period, despite requiring full assistance. Staff interviews confirmed that nail care was the responsibility of CNAs and should be performed when nails are long, but there was no evidence this was done until after surveyor intervention. Another resident, with severe cognitive impairment and multiple medical diagnoses, required partial to moderate assistance with oral hygiene. Documentation revealed that oral care was inconsistently provided, often only once daily or not at all, with several entries marked as 'No' or 'Resident Refused' without any follow-up or notification to nursing staff. The resident's legal guardian expressed concerns about neglect of oral care, noting a history of neglect prior to admission and poor oral hygiene since admission. Staff interviews indicated that refusals were simply documented without further action or escalation. A third resident, who was always incontinent and had intact cognition, reported receiving incontinence care only once per eight-hour shift, typically just before shift change, and expressed concerns about inadequate care given her use of diuretics. Review of documentation for bathing and incontinence care showed multiple blank or incomplete entries, supporting the resident's report of missed care. The facility's own policy required that residents unable to perform ADLs receive necessary services to maintain hygiene and grooming, but this was not consistently documented or provided.