Failure to Provide Required Assistance With Oral Care
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary assistance with activities of daily living (ADLs), specifically oral care, to a resident who required help. One resident, identified as R73, had diagnoses including dysphagia, cognitive communication deficit, bipolar disorder, and osteoarthritis, and a BIMS score of 12/15 indicating moderately impaired cognition. The quarterly MDS documented that R73 required partial/moderate assistance with oral care. During multiple interviews, R73 reported not being offered help to brush her teeth in the mornings or evenings and stated that supplies to brush her teeth were not brought to her. On observation, R73’s teeth and gums had a buildup of white and brown debris, and she did not have a toothbrush at the bedside. Other cognitively intact residents reported that they had to ask staff to bring their toothbrush and toothpaste, and that if they did not remind staff, the supplies would not be brought. Staff interviews, including with the Staff Development nurse, DON, and CNAs, confirmed that the facility’s expectation and CNA orientation education were that oral care is part of routine AM and PM care and that staff should offer mouth care and set up or perform oral care for residents unable to do it themselves. One CNA who usually worked with R73 in the evenings stated that she sometimes offered to have R73 brush her teeth. These findings show that, despite facility expectations and training materials stating that mouth care should be given in the morning, at bedtime, and as part of personal hygiene, R73 did not consistently receive the necessary assistance and supplies for oral care.
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