Failure to Provide Necessary ADL Assistance Due to Staffing and Equipment Limitations
Penalty
Summary
A deficiency was identified when a resident with chronic obstructive pulmonary disease, congestive heart failure, and morbid obesity was not provided with the necessary care and services to prevent avoidable decline in activities of daily living (ADLs). The resident required a two-person mechanical lift for transfers and was dependent on staff assistance to get out of bed and for bathing. Over multiple observed dates, the resident was not assisted out of bed and was not offered showers, only receiving infrequent bed baths. The resident reported that staff did not ask if they wanted to get out of bed due to insufficient staffing, and that they had not been out of bed for approximately ten days. The care plan indicated the need to encourage participation in ADLs and to use assistive devices, but these interventions were not consistently implemented. Staff interviews confirmed that there were typically only two to three Certified Nurse Aides available for 40 residents, making it difficult to provide the required assistance for residents needing two-person transfers. The resident's preferred seating option, a Broda chair, was no longer available, and therapy services were being provided at bedside due to the resident not being transferred out of bed. The facility's policy emphasized promoting dignity and quality of life, but the lack of staff and resources resulted in the resident not receiving care in accordance with their needs and preferences.