Failure to Provide Required ADL Assistance for Feeding and Bathing
Penalty
Summary
The facility failed to ensure that residents dependent on staff for activities of daily living (ADL) received appropriate assistance with feeding and showers as ordered, recommended by therapy, or according to resident preference. For one resident with hemiplegia and dysphagia, the care plan and physician orders required staff to feed the resident, sit with her, and provide continuous reminders to slow down and chew food thoroughly to prevent choking. Despite these orders and a documented history of choking, staff were observed allowing the resident to eat independently at a rapid pace, taking large bites and not fully chewing or swallowing before taking additional bites. Staff assigned to the resident were unaware of the specific feeding interventions, and the assignment sheets did not accurately reflect the current orders or interventions. There was also no documented evidence that staff had been trained on the required dining interventions for this resident. Another resident, who was totally dependent on staff for bathing due to hemiplegia and impaired cognition, did not consistently receive scheduled showers or baths. Documentation revealed significant gaps between showers, with periods of up to twelve days without a bath or shower. The resident reported not receiving showers as scheduled and expressed a preference for twice-weekly showers, which were not provided. Staff interviews confirmed that the resident often appeared with greasy hair and body odor, and that requests for showers were not consistently fulfilled. Additionally, shower documentation was incomplete or illegible, making it impossible to determine which staff provided care on certain dates. The facility's own policy required residents to be bathed or showered according to their preference at least twice per week, with proper documentation and follow-up if a shower could not be given or was refused. However, there was no evidence of refusals or alternative arrangements documented for the resident who missed multiple showers. The lack of accurate documentation, staff awareness, and adherence to care plans and physician orders led to deficiencies in providing necessary ADL assistance for residents dependent on staff for feeding and bathing.