Failure to Provide Required ADL Care Including Bathing, Incontinence, and Nail Care
Penalty
Summary
Facility staff failed to provide necessary activities of daily living (ADL) care for four residents, resulting in deficiencies related to bathing, incontinence care, and nail care. One resident with multiple complex diagnoses, including severe cognitive impairment and mobility deficits, was not offered a full bed bath or shower at least twice a week as required. Bathing records showed that over a five-day period, the resident received only one partial bath, with no documentation of refusals, despite care plan interventions specifying extensive assistance with bathing. Staff interviews revealed inconsistencies in the understanding and delivery of bathing routines, and observations noted delays in changing soiled clothing after incidents such as vomiting. Another resident, who was totally dependent on staff for ADLs due to spastic quadriplegic cerebral palsy and was always incontinent, was not provided timely incontinence care. Observations throughout the day showed the resident remained in the same location, and when incontinence care was finally provided, the resident's brief, clothing, and wheelchair pad were found to be fully saturated. Staff interviews indicated that care was delayed due to the need for two-person assistance and lack of available staff, despite care plan interventions and facility policy requiring checks and care every two hours. Two additional residents, both dependent on staff for personal hygiene, were not provided adequate nail care. One resident's toenails were observed to be long, and the resident reported being unable to care for them independently. The other resident had long, thick toenails and fingernails that were jagged with debris present. Staff interviews and observations confirmed that nail care was not being performed as required by care plans, with some staff deferring responsibility to a podiatrist. These deficiencies were confirmed through direct observation, staff and resident interviews, and review of facility records and policies.