Failure to Provide Resident-Centered Hygiene Care for Cognitively Impaired Resident
Penalty
Summary
The facility failed to identify and provide needed resident-centered care for a resident with severe cognitive impairment and multiple medical diagnoses, including diabetes, schizophrenia, peripheral vascular disease, and a malignant neoplasm of the prostate. The resident was admitted with a history of declining cognition and, at the time of the deficiency, had a BIMS score indicating severely impaired cognition. Observations and interviews revealed that the resident was frequently found with wet and soiled clothing, a malodorous smell, and evidence of urine and feces on his person and in his room. The resident had a colostomy bag, was incontinent of bladder, and wore incontinence briefs, but insisted on changing them himself. Staff reported that the resident often refused care, including bathing and hygiene assistance, and that no interventions or incentives had been attempted to address his refusals or behaviors such as picking at his colostomy bag, which led to leakage. Despite the resident's inability to consistently perform activities of daily living and maintain personal hygiene, the facility did not implement or attempt additional interventions to ensure his needs were met. Staff confirmed that the resident required supervision, reminders, and encouragement for self-care, but care was only provided upon request or when the resident agreed, with no proactive strategies in place. The facility's lack of action resulted in repeated observations of the resident in soiled clothing, with wet spots on furniture and bedding, and a persistent foul odor in his room and on his person.