Failure to Provide Care-Planned ADL Assistance With Personal Hygiene and Grooming
Penalty
Summary
The deficiency involves the facility’s failure to provide required assistance with activities of daily living (ADLs), specifically personal hygiene and grooming, in accordance with residents’ care plans. One resident with diabetes mellitus, weakness, unsteadiness, dysphagia, anxiety disorder, hypertension, heart disease, GERD, and osteoarthritis had a care plan identifying an ADL self-care performance deficit and requiring one staff member to assist with bathing, personal hygiene, and oral care, including shaving and specific approaches if she resisted care. During observation, this resident was seen in her wheelchair with long gray hairs on her chin, stated she needed a shave, and indicated she liked her chin to be shaved, showing that the planned ADL assistance and grooming were not being carried out as care-planned. Another resident with epilepsy, weakness, morbid obesity, a contracture of the left hand, need for assistance with personal care, generalized anxiety disorder, major depressive disorder, and arthritis also had a care plan documenting an ADL self-care performance deficit and the need for one staff member to assist with bathing, personal hygiene, and oral care. This resident was observed lying in bed with small hairs on her chin and neck area and reported that she had asked to be shaved and wanted staff to shave her chin. A third resident with multiple sclerosis, cognitive communication deficit, dementia, central nervous system disorder, UTI, DVT, dysphagia, and major depressive disorder had a care plan requiring one staff member to assist with bathing, personal hygiene, and oral care. This resident was observed in a wheelchair with a splint on the right hand and long fingernails on the right hand, including a long pinky nail and a ring finger nail with a substance under it, and stated she wanted her nails shorter. The regional nurse consultant confirmed that CNAs are responsible for shaving and nail care (with nurses performing nail care for diabetic residents), and the facility’s ADL policy states that care, treatment, and services are to be provided according to individualized care plans, which was not done for these residents.
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