Failure to Provide Required ADL, Skin, and Grooming Care
Penalty
Summary
The facility failed to provide essential Activities of Daily Living (ADL) care, including showers, eating assistance, skin assessments, and grooming, for one resident who was dependent on staff for these services as outlined in the physician-approved plan of care. Documentation and interviews revealed that the resident required substantial to maximal assistance with bathing, grooming, personal hygiene, dressing, eating, bed mobility, transfer, locomotion, and toileting. Despite these needs, staff interviews confirmed that showers, grooming, and nail care were frequently missed due to staffing shortages and time constraints. Observations and interviews with the resident and family further confirmed infrequent bathing, lack of assistance with eating, and inadequate application of prescribed medicated creams for skin conditions. Medical records and staff statements indicated that physician orders for weekly skin checks and daily application of medicated creams were not consistently followed. Gaps in skin assessment documentation were noted, and the resident was observed to have worsening skin conditions, including redness, wounds, and flaking, as well as a foul odor and unclean appearance. The nurse practitioner and family members reported that the resident's skin condition deteriorated due to missed showers and lack of proper skin care, and that the resident was often found soiled and in dirty clothing. The nurse practitioner also noted that the resident required extensive assistance with eating due to physical limitations, but was observed not receiving adequate help during meals. Grooming deficiencies were also documented, with observations of long, dirty fingernails and confirmation from staff that nail care was not performed regularly. The DON and nurse manager acknowledged that staff were responsible for these tasks and that documentation and care were not provided as required by the resident's plan of care. The cumulative effect of these failures resulted in the resident not receiving care in accordance with professional standards and physician orders.