Failure to Provide Hygiene and Grooming Assistance for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate hygiene and grooming assistance to multiple residents who required help with activities of daily living (ADLs). One resident with hemiplegia, hemiparesis, and muscle wasting, who was alert and oriented and required extensive to total assistance with ADLs, was repeatedly observed in bed with long, dirty fingernails containing brown/black material underneath, overgrown and unkempt facial hair, and crusty eyes. This resident stated he wanted someone to clip his nails and trim his facial hair. Another alert and oriented resident with Parkinson’s disease and gait abnormalities was observed in the dining room on consecutive days wearing the same dirty, stained clothing, with crumbs on his clothes, long dirty fingernails with dark material underneath, and unkempt overgrown facial hair. He reported that it would be nice if staff would clip his nails and trim his facial hair and later stated he could not perform this grooming himself and needed staff assistance. A CNA confirmed that this resident’s condition had declined and he now required assistance with grooming and hygiene. A third resident with vascular dementia, severe cognitive impairment, and a need for maximum assistance with ADLs was observed in group activities and later in a hallway wearing soiled pants stained with an unidentified substance and with overgrown facial hair/whiskers on the chin, with no change in clothing noted over several hours. A fourth resident with dementia, protein calorie malnutrition, depression, anxiety disorder, and anorexia was observed lying in bed on two separate days with extremely oily hair and a thick layer of white flakes, identified by a CNA as likely dandruff, on the front of his shirt. The CNA reported she had not seen this resident showered during her three months of employment. An LPN stated this resident consistently refused showers, while point-of-care bathing records over nearly a month showed missing documentation for most days and only two refusals, despite a care plan indicating the resident needed supervision or touching assistance for bathing. The DON stated that staff are expected to provide grooming and hygiene, including nail care, facial hair care, and ensuring clean clothing, and that personalized care plan interventions and documentation of refusals should be in place for bathing and grooming, which were not evident in these cases.
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