Failure to Promote Resident Dignity in Personal Hygiene and Dining Environment
Penalty
Summary
Facility staff failed to promote dignity for one resident by not maintaining trimmed facial hair on a female resident with severe cognitive impairment and significant ADL self-care deficits. Despite the resident requiring substantial to maximal assistance with personal hygiene and being assessed as sometimes resistant to care, there was no documentation in the clinical record or ADL logs of refusals or attempts to address the facial hair. Multiple observations over several days confirmed the presence of long, curled white hairs on the resident’s chin and upper lip, and staff interviews indicated that personal hygiene, including shaving, should be performed daily and refusals reported and documented, which was not done in this case. Additionally, observations in the dining area revealed that food tray domes containing trash were placed in the center of tables where residents were eating. This practice was observed on multiple occasions and was acknowledged by a nurse as not being a dignified manner for residents to eat. Facility policy requires that all non-edible items be removed from dining tables to maintain a relaxed and social dining environment, but this was not followed during the observed meal times. Both deficiencies were brought to the attention of facility administrative and clinical leadership. No further information or documentation was provided prior to the survey exit regarding these findings.