Failure to Provide ADL, Oral Hygiene, and Nail Care for Three Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate activities of daily living (ADL) care, including hygiene and grooming, to three residents in accordance with its own policies. For one resident with Crohn’s disease, hemiplegia/hemiparesis, and colon cancer who was cognitively intact, surveyors observed on consecutive days that she remained in bed with disheveled, uncombed hair and wearing the same soiled gown with dried liquid stains. The resident reported she was scheduled to receive showers on specific days of the week and stated she had missed a scheduled shower, had not been offered one, and had worn the same clothes for four days. She also stated her hair had not been combed since two days before Thanksgiving, and staff interviews confirmed she did not refuse care and was supposed to receive showers on the days she identified. A second resident, who was PEG-tube fed, had dysphagia, hemiplegia, hemiparesis, and moderate cognitive impairment, was observed lying in bed with a yellowish-tan substance along the lower gum line and between the teeth on two separate occasions. The resident stated he could not take anything by mouth and that staff did not brush his teeth or keep his mouth clean, adding that staff did not have time but needed to take time to provide this care. An LPN and the DON both confirmed the visible soiling of the resident’s teeth and acknowledged that mouth care was expected every shift. A CNA who had provided care the previous day confirmed that she did not brush the resident’s teeth, despite knowing that oral care was expected every shift, and described difficulty providing mouth care due to the resident’s PEG feeding and need to remain upright. The third resident, with type 2 diabetes, a right-hand contracture, and moderate cognitive impairment, was repeatedly observed with fingernails on both hands approximately one inch in length. On further observation, fingernails on the right hand were seen digging into the resident’s palm, and both a CNA and an LPN confirmed that the nails were very long, bent inward toward the palm, and needed trimming. Staff interviews indicated that nurses were responsible for trimming this resident’s fingernails due to his diabetes. The DON acknowledged observing the contracted hands and fingernails digging into the palm and stated that failure to provide nail care services could result in worsening skin breakdown and accidents. These observations and interviews demonstrated that the facility did not provide necessary ADL care, including bathing, grooming, oral hygiene, and nail care, as required by its policies.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.