Failure to Provide Timely ADL Assistance and Incontinence Care
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) for residents who were dependent on staff support. One resident was observed in a geri chair, attempting to sleep while in pain, and stated he preferred to be in bed. Despite multiple staff members noticing his condition, he was not assisted into bed for nearly an hour after his initial request, even though his care plan indicated he was dependent for transfers. Staff interviews confirmed that the resident had asked for help and was told assistance would be provided later, resulting in a prolonged period of discomfort. Another resident reported two separate incidents of inadequate toileting and incontinence care. The first involved being left on a bedpan for an extended period during the night, with conflicting staff statements and dates in the facility's investigation records. The second incident involved the resident being left in a wet brief for over three hours, which led to a skin rash and subsequent treatment with Fluconazole. Documentation and interviews confirmed the resident's complaints and the resulting skin condition, but the facility's grievance logs did not reflect a complaint for the latter incident.