Failure to Provide Adequate Oral Hygiene for Dependent Resident
Penalty
Summary
The facility failed to provide adequate oral hygiene for one of three sampled residents who was completely dependent on staff for all activities of daily living due to severe medical conditions, including ALS, ventilator dependence, and chronic respiratory failure. During observation, the resident was found in bed, unable to verbally respond, with dry, flaky lips and significant white to yellowish debris covering the teeth and tongue. The tongue had a visible film elevated approximately 1/16 of an inch, indicating a lack of proper and consistent oral care. Interviews with facility staff revealed that oral care was not being performed to the required standard. The Director of Staff Development acknowledged that the resident's mouth and tongue needed cleaning and that staff should be providing oral hygiene every shift, but admitted it was not being done adequately. A respiratory technician stated oral care had been attempted earlier but described the resident as difficult to clean, without having reported these difficulties to nursing or supervisory staff. Review of the resident's care plan confirmed the need for staff-assisted oral care, but there was no documentation of any challenges in providing this care. Facility policy required thorough oral hygiene, including cleaning the cheeks, palate, and tongue, and applying lubricant to dry lips, but these procedures were not followed as observed.