Failure to Provide Timely ADL Assistance and Personal Hygiene
Penalty
Summary
Surveyors identified that the facility failed to provide necessary care and assistance with activities of daily living (ADLs) for residents who were unable to perform these tasks independently. Multiple residents were not provided timely incontinence care, were not gotten out of bed as planned, and did not receive consistent showers or personal hygiene. Documentation and interviews revealed that residents often remained soiled for extended periods, sometimes from early morning until the afternoon, and that staff frequently cited insufficient staffing as the reason for not providing care as scheduled. Residents reported feelings of anxiety, depression, and frustration due to these lapses in care, particularly when unable to get out of bed for family visits or when left in soiled conditions. Observations and record reviews showed that several residents had long, dirty fingernails, soiled clothing, and noticeable urine odors, indicating a lack of regular grooming and hygiene. Certified Nurse Aide Accountability Records contained multiple omissions for ADL tasks such as showers, personal hygiene, and toileting, with some residents not receiving showers for extended periods. Staff interviews confirmed that care was often not provided as required, especially when staffing levels were low, and that documentation of care was incomplete or missing. Some staff were unaware of when certain care tasks, such as nail clipping or showers, were last performed. The facility's own policies required regular assistance with ADLs, including toileting, grooming, and hygiene, with documentation to be completed after care was provided. However, interviews with staff and management revealed that these policies were not consistently followed, and that care was sometimes prioritized over documentation, leading to gaps in both care delivery and record-keeping. The Director of Nursing acknowledged awareness of documentation omissions and inconsistent provision of showers, but was not aware of the full extent of the deficiencies. Residents' preferences for getting out of bed and receiving care were not always honored, particularly when staffing was insufficient.