Failure to Provide Adequate Hygiene and Bathing Assistance for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate assistance with activities of daily living (ADLs), specifically hygiene and bathing, for two residents who were dependent on staff. One resident with Alzheimer’s disease, dementia, blindness in one eye, and an MDS indicating dependence on staff for all ADLs, including personal hygiene, was care planned for assistance with dressing, grooming, and personal hygiene. Despite this, surveyors repeatedly observed the resident’s fingernails to be long, yellowed, and visibly dirty with brown buildup and other unknown substances under the nails over several days. Certified nurse aides (CNAs) gave inconsistent descriptions of when nail care was provided (e.g., every Thursday, at every shower, daily, during manicure day), and the DON confirmed there was no specific time nail care was to be performed, only that it should be done as needed. Even after the nails were clipped, surveyors observed that the buildup under the nails remained. The Administrator stated that nails should be kept clean and trimmed to the resident’s desired length and agreed that the observed condition of the nails was unacceptable. The facility’s ADL policy required appropriate hygiene care, including grooming, for residents unable to carry out ADLs independently. The second resident, who was cognitively intact with diagnoses including major depressive disorder, morbid obesity, and Guillain-Barré syndrome, was documented as dependent on staff for bathing and had a care plan focus on ADL self-care performance deficit related to impaired mobility, with an intervention to assist with ADLs such as dressing, grooming, and personal hygiene as needed. The care plan did not specifically address bathing. The resident reported not receiving bathing assistance as scheduled, stating he was supposed to receive help on Wednesdays and Saturdays but did not always get it. Review of documentation for a one-month period showed that the resident received assistance with bathing on only six specified days, with a notation of “NA” (not applicable) on one scheduled bath day, resulting in a nine-day gap without documented bathing assistance. The DON initially did not know what “NA” meant, later confirmed it meant “not applicable,” and acknowledged that the resident went nine days without assistance with bathing and that he should not have gone that long without being offered a bath or shower. The facility’s bathing policy required that residents be offered a means of bathing at least twice a week at a time and by a method of their choosing, recognizing their right to refuse care.
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