Failure to Maintain Resident Dignity and Personal Hygiene Due to Inadequate Staffing
Penalty
Summary
The facility failed to maintain resident dignity and provide adequate personal hygiene for three residents, as evidenced by multiple observations and interviews. Residents were noted to be disheveled, with soiled clothing, untrimmed and dirty fingernails, and, in one case, matted hair. One resident with severe cognitive impairment was observed with dried food on his shirt, food crumbs in his lap, and significant dirt under his fingernails. Another resident, who was cognitively intact but physically dependent, was found with very dry, peeling skin, untrimmed and dirty fingernails, and soiled bedding with food crumbs and stains. This resident reported waiting extended periods for staff to respond to call lights and sometimes refused care due to staff rushing and perceived rudeness, attributing these issues to short staffing. Staff interviews confirmed that chronic understaffing and frequent mandatory overtime led to rushed care and the need to cut corners, particularly in areas such as nail care, hygiene, and timely response to call lights. Certified Nurse Aides reported being mandated to work double shifts, frequent call-ins, and burnout, which resulted in residents not receiving the care they deserved. Staff also indicated that other personnel with CNA licenses rarely assisted with time-consuming tasks like bathing, nail care, and feeding, further exacerbating the problem. Facility policies and job descriptions reviewed during the survey emphasized the importance of maintaining resident dignity and providing assistance with activities of daily living according to care plans. Despite these policies, the observed deficiencies in personal hygiene and resident appearance, as well as resident and staff reports of inadequate care, demonstrated a failure to uphold these standards. The lack of sufficient staffing and support directly contributed to the inability to provide dignified and respectful care to residents.