Failure to Provide Scheduled ADL Care Including Showers, Nail Care, and Shaving
Penalty
Summary
The deficiency involves the facility’s failure to provide activities of daily living (ADL) care, including scheduled showers, nail care, and shaving, to multiple residents who were dependent on staff assistance. The facility’s ADL policy required that, based on comprehensive assessment and resident needs and choices, residents’ abilities in ADLs should not deteriorate and that care and services would be provided for bathing, dressing, grooming, and oral care. A review of the grievance log over several months showed multiple complaints from residents and families about missed baths/showers, shaves, nail care, and lack of skin moisturizing. Despite this, several residents with documented self-care deficits and staff-dependent status for personal hygiene did not receive consistent ADL care as scheduled. One resident with muscle wasting and atrophy, cognitively intact and care planned to receive staff assistance with all ADLs, was scheduled for showers three times weekly on the day shift. Documentation showed only four showers in December, and repeated observations on different days showed the resident unkempt, with disheveled hair, unshaven face, and long fingernails with dirt and brown debris. The resident reported that his bath days were different from what was in the POC, stated he preferred bed baths, and reported not having had one in over two weeks, also expressing a desire for nail clipping and shaving. A nurse supervisor confirmed the resident’s long, dirty nails and unshaven condition. Another resident with hemiplegia and total dependence on staff for personal hygiene, care planned for staff assistance of two, had scheduled shower days twice weekly but was documented as receiving only a limited number of showers in December. Observations on consecutive days showed this resident unshaven with long fingernails containing brown debris, and the unit manager confirmed the lack of shaving and nail care despite the expectation that these tasks be completed on shower days. A third resident with gout and nutritional deficiency, assessed as needing staff assistance with personal hygiene and care planned for a self-care performance deficit, had scheduled showers three times weekly on the night shift. CNA documentation indicated frequent showers throughout December, yet observation of the resident’s feet revealed white, dry, flaky skin, and the unit manager acknowledged that the resident’s skin had not been moisturized and that it would not appear that way if scheduled showers and associated skin care were being provided. A fourth resident with a collapsed vertebra, cognitively intact and requiring staff assistance with personal hygiene, was care planned for staff assistance with all ADLs and scheduled for showers three times weekly on the day shift. Documentation showed only four showers in December, and observation revealed matted, greasy, disheveled hair. This resident reported that her shower days were different from those in the POC and stated she had not had a shower in three weeks, also noting she had not attended activities because of this. A CNA reported that this resident had not received showers due to CNA short staffing. The DON stated her expectation that residents receive scheduled showers three times weekly and as needed, with nails clipped and faces shaved on shower days and as needed, and that CNAs and unit managers were responsible for following POC shower schedules and documentation.
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