Failure to Provide Required ADL Assistance Including Eating and Toileting
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically eating and toileting, for four out of seven residents reviewed. Facility policy and CNA job descriptions require staff to assist residents with ADLs according to care plans, including feeding, toileting, and maintaining hygiene. However, documentation and interviews revealed that these services were not consistently provided. For example, one resident with hemiplegia and chronic pain, who required total assistance with meals, was not offered their meal tray, did not receive help with dentures, and was not assisted during the lunch period, as confirmed by both staff and the Assistant Director of Nursing. Another resident with depression, anxiety, and diabetes reported frequent delays in toileting assistance, resulting in episodes of incontinence and prolonged periods sitting in soiled briefs. Documentation showed significant gaps between toileting times, sometimes exceeding ten hours, and missing evidence of toileting on several night shifts. The resident stated that staff instructed them to soil themselves in the dayroom due to lack of timely assistance. Additional residents with similar medical conditions, including high blood pressure, diabetes, and cardiac arrhythmia, also reported long waits for toileting help, especially during night shifts, and documentation confirmed multiple shifts without evidence of toileting assistance. Staff interviews corroborated these findings, with reports of insufficient staff coverage, particularly overnight, leading to residents waiting extended periods for help. Residents described having to attempt self-care due to lack of timely staff response, and staff confirmed that expected ADL assistance was not provided. The Nursing Home Administrator acknowledged the failure to provide required ADL support, including eating and toileting, for the affected residents.