Failure to Provide Adequate ADL Assistance and Environmental Control Resulting in Myiasis
Penalty
Summary
A dependent resident with multiple sclerosis, neuromuscular dysfunction of the bladder, seborrheic dermatitis, and cellulitis of the head was not provided with adequate assistance for activities of daily living (ADLs), including personal hygiene. The resident required staff assistance for bed mobility, oral hygiene, toileting, eating, bathing, and transfers, and had physician orders for medicated shampoo and topical creams to be applied to the scalp. Documentation revealed missed or undocumented bathing and shower care on multiple dates, and the resident reported not receiving prescribed scalp medications prior to a hospital transfer. The resident was later found to have live maggots in her hair and scalp, prompting immediate intervention and notification of hospice and the physician. Environmental factors contributed to the deficiency, as the facility had ongoing issues with flies in the resident's room, which may have exposed the resident's scalp wound. Pest control invoices confirmed fly activity during the relevant period, and both nursing and maintenance staff acknowledged persistent fly problems. The lack of consistent ADL care, incomplete documentation, and environmental pest issues led to the resident's compromised hygiene and the development of myiasis (maggot infestation) in the scalp.