Failure to Provide Timely ADL Assistance and Maintain Resident Dignity
Penalty
Summary
Two residents with significant care needs did not receive appropriate assistance with activities of daily living (ADLs), specifically in the areas of personal hygiene, grooming, and toileting, as required by their care plans. One resident, who was totally dependent on staff for personal hygiene and oral care due to multiple diagnoses including a femur fracture, failure to thrive, prostate cancer, anxiety disorder, and heart failure, was observed in the dining room in pajamas with unkempt hair and long, scraggly whiskers. Documentation for this resident's bathing, grooming, and hygiene was either missing or marked as not applicable for multiple consecutive days, and only the night shift was documenting these cares. The resident expressed dissatisfaction with his appearance and reported needing assistance with shaving and grooming, which was confirmed by staff interviews indicating a lack of clear guidelines on the frequency of shaving and grooming tasks. Another resident, with diagnoses including Parkinson's Disease, neuromuscular bladder dysfunction, muscle weakness, and cognitive impairment, was observed multiple times in soiled clothing and with a strong odor of urine. This resident required two-person assistance with transfers and toileting, as documented in the care plan, and was to be changed every two hours. However, staff interviews revealed that the resident was often left in wet briefs and clothing for extended periods, with some staff admitting that changes were not performed as scheduled, sometimes due to the resident's combative behavior. Documentation of care refusals was inconsistent, with only one refusal recorded in the relevant period, despite staff claims of frequent refusals. Observations and interviews confirmed that both residents did not receive the necessary services to maintain good hygiene, grooming, and dignity as outlined in facility policy and their individualized care plans. Staff failed to provide timely and adequate assistance with toileting and personal care, resulting in one resident being left in urine-soaked clothing and another with unaddressed grooming needs. These failures were corroborated by direct observations, resident interviews, and staff admissions, demonstrating a lack of adherence to established care protocols and policies.