Failure to Provide Timely Assistance with ADLs Including Showers, Oral Care, and Nail Care
Penalty
Summary
The facility failed to provide timely and adequate assistance with activities of daily living (ADLs), including showers, oral care, and nail care, for multiple residents who were dependent on staff for these needs. Several residents were observed with unkempt hair, soiled clothing, and poor oral hygiene, and interviews with residents and their representatives revealed that scheduled showers and personal care were frequently missed or delayed. Documentation showed that some residents received only a fraction of their scheduled showers over a 30-day period, and in some cases, there was no documentation of bathing or showering for extended periods. Staff interviews confirmed that there were no shower aides scheduled on certain days, particularly Sundays, resulting in missed care for residents scheduled on those days. One resident with severe cognitive impairment and total dependence on staff for hygiene was repeatedly found unkempt, with oily hair, soiled briefs, and visible buildup in their mouth. Their representative reported not witnessing oral care being provided and noted that showers were not given as scheduled. Another resident, who was cognitively intact but physically dependent, was observed with yellowed teeth and buildup, and stated that staff did not offer assistance with oral care. Additional residents reported or were observed to have gone days without showers, with one resident stating they had only received one shower in nearly two weeks, and another with long, dirty fingernails despite orders for weekly diabetic nail care. Staff interviews revealed that high workload, lack of scheduled shower aides, and inconsistent documentation contributed to the missed care. Staff acknowledged that showers scheduled for Sundays were not being provided due to lack of staff, and that care was sometimes deprioritized or not documented. Care plans and schedules reviewed did not always reflect person-centered preferences or provide clear guidance on the frequency of care, further contributing to the deficiencies in meeting residents' ADL needs.