Failure to Provide Adequate Assistance with ADLs and Personal Hygiene
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) to several residents who were unable to perform these tasks independently, resulting in inadequate personal hygiene. Multiple observations and interviews revealed that residents with significant cognitive and physical impairments did not receive timely or appropriate care as outlined in their individualized care plans. For example, one resident with moderate cognitive impairment, hemiplegia, and incontinence was repeatedly observed with long, dirty fingernails, extremely dry and flaky feet, and soiled bedding. Staff interviews confirmed that the resident had not been checked or cleaned according to the facility's protocol, and there was confusion among CNAs regarding assignment responsibilities. Another resident with moderate cognitive impairment and lower extremity impairment was observed with long, thick, and jagged toenails, including a purple discolored toenail, and dry, flaky feet. The resident expressed a desire for assistance with beard trimming and toenail care, which had not been provided. Staff interviews indicated that there was no documentation of the resident refusing care, and the nurse manager acknowledged that staff should have noticed and reported the discolored toenail and provided appropriate foot care and hygiene support. A third resident with severe cognitive impairment and hemiplegia was observed with long, dirty fingernails and soiled clothing after eating with their hands. Staff did not adequately clean the resident's hands or fingernails, and the resident reported dissatisfaction with their hygiene and appearance. Interviews with staff and management confirmed that the resident required maximum assistance with ADLs and that staff were expected to provide nail care, change soiled clothing, and assist with hand hygiene, but these tasks were not consistently performed. The care plan did not include specific interventions for refusals of care, and staff described challenges in providing care to residents who sometimes refused or became combative, but there was no evidence of consistent re-approach or alternative strategies documented.