F0677

D

Failure to Provide Required ADL Hygiene and Grooming Care to Dependent Residents

Dallas, Texas Survey Completed on 01-14-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide necessary ADL assistance, including grooming and hygiene, to dependent residents. One male resident with hemiplegia affecting the left dominant side and a contracture of the left hand was totally dependent on staff for ADLs per his MDS and care plan. He filed a grievance on 12/17/25 about his fingernails not being trimmed. Photographs dated 01/05/26 provided by his responsible representative showed fingernails on both hands at least a half-inch long with thick black substance under some nails. The resident reported he had been requesting nail trimming for weeks from CNAs, a male nurse, and another staff member checking on residents, and that his long nails were digging into the palm of his contracted left hand. His responsible representative stated she had also been attempting for weeks to get his nails trimmed and had been assured by nursing staff and the Administrator that it would be done, but the nails were not trimmed until early January.

A female resident with hemiplegia affecting the left dominant side, physical debility, severe cognitive impairment, and total dependence for ADLs was care planned as being at risk for skin breakdown and totally dependent on staff for ADL care. Review of her clinical record on 01/14/26 initially showed only one shower form dated 10/17/25 uploaded in the system. After this was brought to the attention of the ADON and DON, the facility produced additional shower/bed bath forms for December 2025 and January 2026, documenting bed baths on 12/05/25, 12/11/25, 12/16/25 (refused due to cold water), 12/20/25, 01/02/26, and 01/10/26. The resident stated she liked getting bed baths but had not been receiving them consistently, reporting that she had only received one bed bath in the prior week, needed her hair washed, and had not refused any bed baths.

Staff interviews confirmed expectations and responsibilities related to ADL care that were not met. The LVN charge nurse for the hall stated she was unaware of the male resident’s untrimmed nails and indicated CNAs on the 2 PM–10 PM shift should check and trim nails during showers. She also stated that evening CNAs were responsible for the female resident’s showers and bed baths, that the resident was scheduled for showers three times weekly, and that it was her and the ADON’s responsibility to ensure residents received showers or bed baths. The ADON stated charge nurses were responsible for ensuring showers/bed baths and nail care were completed, that CNAs must complete showers/bed baths as scheduled, and that shower forms must be signed by nurses and uploaded to the record. He acknowledged being informed by the surveyor that only one shower sheet was uploaded for the female resident and said he would research the missing forms. The DON stated CNAs complete shower sheets, nurses sign them, and they are then scanned into the record, and that ADONs should be checking to ensure residents receive showers or bed baths. The facility’s ADL policy stated that appropriate care and services will be provided for residents unable to carry out ADLs independently, including assistance with hygiene such as bathing, dressing, grooming, and oral care.