Failure to Provide Scheduled Bathing and Nail Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure that dependent residents received activities of daily living (ADL) care, specifically bathing and nail care, as assessed and care-planned. One resident with intact cognition and multiple diagnoses, including diabetes, morbid obesity, COPD, chronic respiratory failure, and psychiatric conditions, had a quarterly MDS showing she required only setup or cleanup assistance for eating and was otherwise independent with oral hygiene, toileting, dressing, and personal hygiene. Review of her shower documentation showed no shower or bath recorded for two separate multi‑day periods, and the DON confirmed there was no evidence she received showers twice weekly as expected. Another resident with dementia, bipolar disorder, depression, anxiety, peripheral vascular disease, diabetes, and chronic kidney disease had an MDS indicating cognition was not intact and that she was dependent on staff for personal hygiene. Review of her shower records showed that showers or baths were not consistently provided twice weekly across multiple months. The DON verified that showers were not completed twice a week for this dependent resident, indicating that scheduled bathing needs were not met according to her assessed level of dependence. A third resident, cognitively intact with significant respiratory diagnoses and morbid obesity, was care‑planned as at risk for ADL decline and required dependent assistance for transfers, bed mobility, toileting, and showering, with maximum assistance for personal hygiene and nail care to be done on shower days or as needed. Documentation from mid‑November through mid‑January showed nail care consistently marked as N/A, with no indication that staff attempted nail care when the resident refused, and multiple scheduled shower/bed bath days lacked any record of bathing or nail care. The resident reported he had not left bed since July and that his nails had not been cared for during that time; observations showed long, soiled fingernails with brown debris and yellowing. The DON confirmed that N/A meant staff did not attempt nail care and that nail care had not been provided, and an LPN acknowledged the resident’s nails were long and visibly soiled and could not identify when nail care was last completed. The facility’s ADL policy required provision of bathing and grooming care unless decline was unavoidable or care was refused with appropriate documentation, which was not reflected in the records reviewed.
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