Failure to Provide Adequate ADL Assistance and Hygiene Prior to Meal
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment, Alzheimer's disease, and an above-elbow amputation was not provided adequate assistance with activities of daily living (ADLs), specifically personal hygiene and grooming. The resident required extensive assistance for bed mobility, transfers, and toileting, and had a care plan in place for incontinence care and ADL deficits. Despite these documented needs, the resident was observed with a brown substance, later identified as BM, smeared on her right cheek and under her fingernails prior to and during a meal. The resident was also noted to have a noticeable odor of BM. Staff interviews revealed that the CNA responsible for the resident's care before the meal stated she had cleaned the resident's hands with a wipe but did not notice the residue on the face or under the nails until it was pointed out by the surveyor. The CNA later confirmed the substance was BM and cleaned the resident after the issue was identified. Other staff members acknowledged the importance of assisting residents with hand hygiene, especially before meals, and recognized the risk of infection if this care was not provided. The facility did not have a specific policy for ADL care, relying instead on a general infection control policy. The observations and interviews demonstrated that the resident did not receive the necessary assistance to ensure proper hygiene before eating, as required by her care plan and her documented needs. The failure to provide this assistance resulted in the resident eating with soiled hands and face, with staff only addressing the issue after it was brought to their attention by surveyors.