Failure to Provide Consistent ADL Assistance and Hygiene Care
Penalty
Summary
Surveyors identified that the facility failed to provide necessary assistance with activities of daily living (ADLs) for three out of six residents reviewed. One resident, who was dependent on staff for showering and transfers due to physical and cognitive limitations, did not receive scheduled showers as required by facility policy. Documentation showed that out of 20 scheduled opportunities, only five showers were provided, with most other instances recorded as bed baths and no consistent documentation of refusals. The resident expressed a preference for showers and dissatisfaction with the inconsistency, noting that staff found it burdensome due to the need for a mechanical lift and two-person assistance. Staff interviews confirmed that showers were often missed due to staffing challenges and that the resident required regular hygiene due to incontinence. Another resident with severe cognitive impairment and extensive ADL needs was observed in bed throughout multiple days, missing scheduled social activities and not receiving showers as scheduled. Staff interviews revealed that decisions to keep the resident in bed and forego showers were made by CNAs based on staffing levels and workload, without consultation with nursing staff. Documentation indicated that showers were frequently replaced with bed baths, and refusals were not consistently documented. Nursing staff acknowledged that supervision of CNAs was lacking due to competing responsibilities, such as medication administration, and that communication between CNAs and nurses regarding care delivery was insufficient. A third resident, who had self-care deficits and was occasionally incontinent, was repeatedly observed in soiled clothing and bedding with a strong odor of urine present in their room and on their person. Despite care plans indicating the need for regular incontinence care and hygiene assistance, there was no documented evidence of refusals, education, or social work support related to hygiene. Staff interviews confirmed that the resident did not consistently refuse care and that soiled conditions persisted for extended periods. Supervisory staff were aware of the ongoing hygiene issues but could not provide evidence of recent interventions or consistent follow-up to address the resident's needs.