Failure to Provide Adequate ADL Assistance for Grooming and Oral Hygiene
Penalty
Summary
Surveyors found that the facility failed to provide necessary assistance with activities of daily living (ADLs), specifically in the areas of grooming and oral hygiene, for two residents who were unable to perform these tasks independently. The facility's policy required staff to assist residents with ADLs such as showering, toileting, dressing, and grooming, as documented in each resident's care plan. However, observations and interviews revealed that these services were not consistently provided as required. One resident with a history of cerebral infarction, aphasia, and hemiplegia was observed multiple times with long, sharp fingernails and poor oral hygiene, including foul-smelling breath and a white film on their teeth. Despite documentation indicating that oral care was provided twice daily, both family and staff interviews confirmed that oral and nail care were not consistently performed. Staff expressed confusion about their responsibilities, with some believing that only licensed staff should perform nail or oral care for this resident due to their medical condition, while others simply did not notice the need for care. Another resident, who required maximum assistance for most ADLs due to renal abscesses, osteomyelitis, and discitis, was repeatedly observed with long, yellowed fingernails and brown or black debris under the nails. The resident expressed dissatisfaction with the lack of nail care, stating they could not get anyone to trim their nails. Staff interviews confirmed that nail care was not performed as needed, despite the resident not refusing care and the expectation that such care should be provided on shower days or as needed. Nursing staff acknowledged the deficiency but could not explain why the care was not completed.