Failure to Provide Assistance with Activities of Daily Living 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. Specifically, three residents were observed to have unmet needs in the areas of personal hygiene, grooming, and mobility. One resident with severe cognitive impairment and a history of deep vein thrombosis was observed lying in bed on multiple occasions, with no evidence of being assisted out of bed to their wheelchair, despite care plans and medical recommendations indicating the need for regular out-of-bed time and participation in meals and activities outside the resident's room. Interviews with staff revealed that changes to the get-up schedule and staff assignments resulted in this resident no longer being routinely transferred out of bed, contrary to their care plan and physician recommendations. Another resident, also severely cognitively impaired and dependent on staff for personal hygiene and grooming, was observed with long, jagged, yellow and brown stained fingernails. The care plan for this resident required regular nail care due to fragile skin and risk of self-injury. However, the assigned Certified Nurse Aide stated that nail care was only performed on Fridays as part of their personal routine, and if the aide was not assigned to the resident on that day, the nail care was missed. The aide was unaware of the facility's policy regarding nail care frequency, and the resident's nails were not addressed even when observed by nursing staff during medication administration. A third resident, with severe cognitive impairment and dependent on staff for ADLs, was repeatedly observed with dirty, brown-stained fingernails, including while eating meals. Staff interviews revealed that nail cleaning was inconsistently performed, often only during scheduled showers or when activities staff were available. Some staff acknowledged seeing the dirty nails but did not attempt to clean them, and there was a lack of clarity among staff regarding responsibility for ensuring nail hygiene. Nursing staff stated that nail checks were supposed to be part of skin assessments on shower days, but this was not consistently done, resulting in prolonged periods where the resident's nails remained unclean.