F0677

E

Failure to Provide Consistent Bathing, Hygiene, and Nail Care for Multiple Dependent Residents

Town And Country, Missouri Survey Completed on 01-13-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide adequate activities of daily living (ADL) care, including bathing, personal hygiene, oral care, shaving, and nail care, as required by residents’ assessed needs and facility policy. The facility’s ADL policy required that residents’ abilities in ADLs not deteriorate unless decline was unavoidable, and that residents unable to carry out ADLs receive necessary services to maintain grooming and personal and oral hygiene. Multiple cognitively intact residents reported not receiving showers or adequate hygiene despite documentation indicating showers or baths were provided, and there was no documentation of refusals or unavoidable reasons for missed care. Staff interviews revealed inconsistent understanding of responsibilities for nail care and grooming, and acknowledgment that heavy care assignments sometimes resulted in showers not being completed.

One resident with osteomyelitis, diabetes, and a PICC line was documented as having received several showers, yet was observed with long facial hair, odor, and reported never having had a shower because staff would not remove a foot dressing or cover the PICC line. Another resident with ALS, muscle wasting, dysphagia, and full dependence for ADLs was scheduled for showers twice weekly but reported not having had a shower for the entire month, feeling dirty, and wanting hair washed; staff confirmed that heavy care on the hall sometimes led to showers not being done. A resident with a gastrostomy and history of sepsis, dependent for bathing, had long gaps of 6–18 days without documented showers or baths, appeared with oily skin and disheveled hair, and stated they had not received a shower in weeks and were told equipment was not working or lifts were not charged, while staff were unaware of any non-functioning lifts and there was no documentation of refusals.

Additional residents with ADL self-care deficits and dependence on staff also lacked appropriate bathing and hygiene. One resident with cirrhosis and encephalopathy reported never receiving a shower or hair wash since admission, only wipe-downs, and remained with very dry skin and oily, stringy hair; staff later stated a shower chair was available on another floor despite the resident being told none was available. Another resident with dementia, stroke, and on hospice care was documented by hospice as receiving bed baths, yet was repeatedly observed with an unshaven face, long fingernails with dark matter underneath, oily face, and white flakes in neck folds, and later only partially shaved with nails still long and dirty. A newly admitted resident with severe cognitive impairment and dependence for bathing and oral hygiene had no January shower documentation and was observed with teeth caked with yellow matter and fingernails with brown matter underneath.

The deficiency also included failures in nail and grooming care for several residents who required staff assistance. One resident with Alzheimer’s disease, chronic kidney disease, depression, and Parkinson’s disease, who required moderate assistance for personal hygiene, was repeatedly observed with long, jagged fingernails and requested nail care, while a CNA stated nurses were responsible for trimming nails and was unsure where to find nail files. Another resident with Alzheimer’s disease and muscle weakness, dependent on staff for hygiene, was observed multiple times with long, jagged nails and matter underneath, with staff indicating that either the nurse or hospice nurse could trim nails. A resident with Parkinson’s disease and severe cognitive impairment, fully dependent on staff, was observed on multiple days with long, oily hair, an unkempt beard, and uneven, dirty nails. Interviews with CNAs, nurses, the regional nurse, DON, and administrator showed conflicting statements about who was responsible for hair appointments and nail trimming, and confirmed expectations that residents receive showers or bed baths at least twice weekly and that refusals be documented, which did not consistently occur.

Overall, the survey findings showed that despite policies and care plans requiring regular bathing, grooming, and nail care, multiple residents did not receive showers, bed baths, shaving, or nail care as needed or requested, and documentation did not support refusals or unavoidable reasons for missed care. Residents reported feeling dirty, embarrassed, or forgotten, and observations repeatedly showed oily hair, unshaven faces, long and dirty fingernails, and inadequate oral hygiene. Staff acknowledged workload issues and demonstrated inconsistent understanding of roles and documentation requirements, contributing to the failure to ensure residents received appropriate ADL care in accordance with their needs and the facility’s own policy.