Failure to Provide Necessary ADL Assistance and Hygiene Prior to Hospital Discharge
Penalty
Summary
A resident with multiple complex medical conditions, including acute kidney failure, end stage renal disease, protein-calorie malnutrition, dysphagia, cognitive communication deficit, and aphasia, was admitted to the facility and required significant assistance with activities of daily living (ADLs). The resident's care plan indicated total dependence on staff for bathing and showering, and partial to moderate assistance for dressing. The care plan also addressed oral and dental health, with interventions for monitoring and maintaining oral hygiene. The resident had a Brief Interview for Mental Status (BIMS) score of 11, indicating moderate cognitive impairment and a need for staff support in daily care tasks. On the date of a change in condition, the resident was sent to the hospital. Upon arrival, hospital staff observed that the resident was in dirty clothes, a soiled brief, had unclean skin, and an odor, requiring immediate cleaning and changing. Family members also reported multiple instances prior to the hospital transfer where the resident was found in soiled briefs, with unbrushed and tangled hair, unbrushed teeth, and dirty gowns, necessitating requests to staff for basic hygiene care. The family stated that the resident's hair had to be cut due to lack of grooming by facility staff. These observations were corroborated by hospital staff interviews, which indicated the resident was non-communicative and fully dependent on staff for all ADLs. Interviews with facility staff, including CNAs and the RN on duty, revealed that none of the CNAs on the shift when the resident was discharged to the hospital recalled assisting with changing the resident's brief or clothing. The RN stated that a CNA had changed the resident, but could not recall who it was. The Director of Nursing and Administrator both stated that it was their expectation that residents be clean and appropriately dressed when discharged, but were unaware of any issues with this resident's discharge. Review of facility policies confirmed the requirement to provide necessary care for residents unable to perform ADLs, including maintaining proper grooming and hygiene.