Failure to Provide Timely ADL, Hygiene, and Incontinence Care
Penalty
Summary
The deficiency involves the facility’s failure to provide activities of daily living (ADL) care, including hygiene and incontinence care, to maintain or improve residents’ abilities and respect their choices. During a tour, surveyors observed one resident lying in bed awake, screaming in pain, wearing only an incontinence brief with no sheets or blankets, unshaven, with unkempt hair, and in a room with a strong urine odor. Another resident was observed in bed with the head of the bed elevated, eyes closed, unshaven, and with unkempt hair. Two additional residents’ rooms had strong urine odors; one resident reported waiting for someone to change her after staff said they would get someone but never returned, and another resident stated she had been waiting to be changed, had pressed her call light, and that it usually took staff more than 30–45 minutes to respond depending on the time of day. Follow-up observations showed that the first resident remained in bed in a hospital gown with facial hair and unkempt hair, and another resident continued to appear unshaven and ungroomed. One resident reported not having had a shower since admission two weeks earlier, stating that he had only received a sponge bath and preferred to get up for a shower. Record reviews showed that a resident with a displaced femur fracture, dementia, PTSD, anxiety, and dependence on staff for all ADLs had not received a bath since admission, despite documentation that he was incontinent of bowel and bladder and had severe cognitive and mobility impairments. Another resident with diabetes, fractures, multiple myeloma, cirrhosis, wheelchair use, and frequent incontinence had a care plan for ADL self-care deficit and incontinence risk, and a further resident with a fibula fracture, UTI, metabolic encephalopathy, and need for personal care required moderate to dependent assistance with ADLs and had a care plan for ADL self-care deficit and incontinence risk. Documentation for the resident with the fibula fracture showed only periodic bed baths and no showers, despite his stated preference for showers. A resident with hypertensive heart disease, history of TIA and cerebral infarction, wheelchair use, maximal assistance needs for ADLs, and constant incontinence had a care plan for decreased ADL ability and a preference not to be awakened at night for incontinence care. Another resident with a CVA, right-sided hemiplegia, COPD, UTI, and hypertensive heart disease, who required partial to maximal assistance with ADLs, reported having to sit at the nurses’ desk waiting for help to use the bathroom, stating that call lights took over 30 minutes and sometimes up to an hour to be answered. An RN reported that CNAs did not make rounds or provide proper care, that she had written up CNAs without seeing changes, and that staffing was sometimes short. The DON acknowledged multiple grievances about delayed call light response and care not being provided timely, stated that care should be done every two hours and as needed and call lights answered within 5–10 minutes, and indicated that while she had spoken to staff, there was no formal, documented training related to these issues. The facility’s incontinence policy stated that residents should receive care and services to promote urinary continence.
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.