Failure to Provide Assistance with Activities of Daily Living for Multiple Residents
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for four out of five residents reviewed, resulting in unmet care needs. One resident with dementia, heart failure, and macular degeneration required substantial to maximum assistance with ADLs and was at risk for pressure ulcers. Despite care plans specifying nail care and scheduled toileting, the resident was observed with dirty, untrimmed fingernails and left seated in the same position for over three hours without repositioning or being offered toileting. Staff interviews confirmed that toileting and repositioning were not consistently provided, and nail care was not documented or performed as required. Staff cited inadequate staffing as a barrier to providing timely care. Another resident, dependent on staff for all ADLs and always incontinent of bowel, was reportedly left in soiled briefs overnight and through multiple shifts, as evidenced by staff initials remaining on the brief from the previous day. Multiple nursing assistants reported being unable to complete regular check and changes due to chronic understaffing, particularly during evening shifts. The director of nursing confirmed that the expectation was for residents to be checked and changed every two hours, but this was not consistently achieved. Additional deficiencies were noted for two other residents. One resident with multiple medical conditions, including an indwelling catheter, did not receive morning hygiene or catheter care, and the care plan lacked documentation for ADL status and catheter care. Staff confirmed that due to time constraints, only minimal care was provided, and catheter care was omitted. Another resident requiring maximum assistance for personal hygiene and dressing did not receive scheduled bathing or shaving, with staff and the resident attributing the missed care to short staffing. Documentation of refusals and care provided was incomplete or missing.