Failure to Provide Consistent ADL Care and Hygiene for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident who was dependent on staff for activities of daily living (ADLs) did not consistently receive necessary services to maintain good nutrition, grooming, and personal and oral hygiene. The resident, who had severe cognitive impairment, cancer, non-Alzheimer's dementia, depression, and pain disorder, required substantial assistance with personal hygiene and bathing. Record reviews showed no documentation of showers, bed baths, or nail care being provided or refused, and there was no communication between the hospice agency and facility staff regarding these ADLs. During observation, the resident was found in bed with uncombed hair, an unpleasant body odor, facial hair growth, and long, dirty fingernails. The resident reported not receiving showers or bed baths for weeks and expressed a desire for improved hygiene and nail care. Interviews with CNAs and hospice aides revealed confusion and lack of clarity regarding responsibility for providing and documenting ADL care, with both facility and hospice staff assuming the other party was responsible. Neither group consistently reported refusals or lack of care to the charge nurse, and documentation was not shared between the hospice agency and the facility. Facility policies required collaborative communication between hospice and facility staff and mandated that all residents unable to perform ADLs independently receive necessary care. However, the lack of documentation, communication, and follow-through resulted in the resident not receiving regular showers, bed baths, or nail care, as observed and confirmed by staff and the resident herself.