Failure to Provide Adequate ADL Assistance and Hygiene for Dependent Residents
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs) and maintain proper hygiene and grooming for two residents who required such care. One resident with lymphedema, autism, ADHD, and expressive language disorder was dependent for ADLs and weighed 544 pounds. Despite physician orders for regular showers to prevent skin breakdown, documentation showed the resident received showers less frequently than ordered. Staff interviews confirmed that multiple staff were needed for transfers, the shower bed did not fit properly in the shower room, and the resident could not be fully cleaned during showers. The resident experienced pain and shearing injuries during transfers, and the physician's orders were changed due to these difficulties, but the resident still did not receive showers as ordered. Another resident with a history of intracranial injury, psychosis, Alzheimer's disease, and impaired cognitive processes was observed in unsanitary conditions on multiple occasions. The resident's room and bathroom had visible smears of stool and blood, soiled linens, and personal hygiene was neglected, as evidenced by impacted fingernails and open sores from skin picking. Staff confirmed the resident was a 'picker' and often smeared stool and blood throughout the room. The care plan did not address these behaviors, and staff interviews revealed that while the resident received some hygiene care on scheduled days, there was no individualized plan to manage the behaviors affecting cleanliness and hygiene. Facility policy required that residents unable to perform ADLs receive necessary services to maintain hygiene and grooming, but observations, record reviews, and staff interviews demonstrated that these standards were not met for the two residents. The lack of individualized care planning and failure to follow physician orders for hygiene contributed to the deficiencies observed.