Failure to Provide Required ADL Assistance to Dependent Residents
Penalty
Summary
The facility failed to provide appropriate assistance with activities of daily living (ADLs) for two dependent residents. One resident reported that a staff member instructed her to walk without her walker or gait belt over a weekend, despite not being cleared by therapy to do so. Staff interviews confirmed that the resident should have used a gait belt and four-wheeled walker for transfers and walking, as indicated by her therapy evaluation. The staff member who encouraged the resident to walk without these aids stated he was told during shift report that she did not need them. Another resident was found by family members wet and still in bed at 12:30 p.m., indicating that necessary ADL care had not been provided that morning. Staff documentation and interviews revealed that the resident was very sleepy and not waking up, and the staff member on duty allowed her to sleep, having been informed during shift report that the resident had a rough night. The staff member later expressed regret for not being more proactive in waking and toileting the resident.