Failure to Provide Timely ADL Assistance and Restorative Care
Penalty
Summary
Two residents did not receive appropriate assistance with activities of daily living (ADLs) to maintain their highest practicable physical well-being. One resident, who had a perirectal abscess with a large residual wound following surgery, experienced delays in receiving timely toileting and incontinence care. This resident reported multiple instances where staff did not respond promptly to call lights, resulting in prolonged periods of sitting in urine or stool. Documentation and interviews revealed that staff sometimes failed to properly clean the resident after incontinence episodes, and on at least one occasion, a staff member declined to provide care, leaving the resident soiled until seen by outside wound clinic staff. The resident expressed discomfort, embarrassment, and concern that inadequate care could affect wound healing. Facility staff, including the Director of Nursing and Social Worker, were not consistently aware of these incidents or the related wound clinic notes. Another resident, with diagnoses including diabetes with polyneuropathy and repeated falls, was discharged from physical therapy with a recommendation for a restorative ambulation program. The program specified ambulation in the hallway once per shift with caregiver assistance. However, the resident's care plan did not include this ambulation or a restorative program, and staff were unaware of the walking schedule. Documentation showed that the resident was not consistently ambulated as recommended, with the majority of opportunities for ambulation marked as 'not applicable,' indicating the task did not occur. The resident expressed a desire to walk in the hallway with staff and reported not walking much since therapy ended. Facility policies required staff to provide timely responses to call lights, maintain residents' ADL abilities, and implement restorative nursing programs as indicated by assessments and therapy recommendations. In both cases, the facility failed to follow its own policies and procedures, resulting in residents not receiving necessary care and services to maintain their physical functioning and dignity.