F0677

E

Failure to Provide Consistent ADL Assistance and Hygiene Care for Multiple Dependent Residents

Gary, Indiana Survey Completed on 02-24-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide and document adequate assistance with activities of daily living (ADLs), including oral care, shaving, nail care, bathing, personal hygiene, and incontinence care, for multiple dependent residents. One resident reported that staff did not set him up to brush his teeth and that shaving with dull razors was "very brutal"; he stated he would like an electric razor but none had been offered. Over several days of observation, this resident repeatedly had a large amount of facial hair and there was no evidence that oral care had been provided, despite care plan interventions specifying oral hygiene in the morning, after meals, and at bedtime, with partial to moderate assistance. When a CNA searched his drawers, no toothbrush or toothpaste could be found, and the CNA acknowledged she had not completed or set up oral care, even though documentation in the CNA task section indicated oral hygiene and personal hygiene had been provided on nearly all days, with no refusals noted.

Another resident was repeatedly observed with food on his clothes, crumbs in his beard, a dry face with peeling skin, greasy hair, and dried mucus hanging from his nose while staff were present but did not clean his face. On one occasion, he was returned to the dining room after being checked for incontinence with his nose cleaned, but later the same day he was observed with the front of his pants and between his legs wet. The CNA caring for him stated she was supposed to check and change residents at least every two hours and reported that she had last checked him before lunch when he was dry, and then after lunch when he would not let her check him, with no further checks until the time he was found wet. Documentation showed he required supervision with eating and personal hygiene and substantial to maximum assistance with toileting and toilet transfers, and that he was mostly incontinent. CNA task documentation showed personal hygiene signed out every shift for the last 14 days, with no documentation of refusals, despite repeated observations of unaddressed hygiene needs.

Additional residents were observed with persistent facial hair, long or dirty fingernails, and inconsistent bathing. One resident with Alzheimer’s disease and dementia was seen multiple times over several days with a large amount of white facial hair on her chin and face, despite care plan interventions for partial to moderate assistance with personal hygiene and no documentation of refusals for personal hygiene during the review period. Another resident with depressive and psychotic disorders and dementia was observed with a growth of facial hair and dirty fingernails, reported it had been several days since he had been shaved and that he preferred to be clean shaven, and continued to have dirty fingernails even after being shaved; his care plan required substantial to total dependence on staff for personal hygiene, with no refusals documented. A further resident with type 2 diabetes and vascular dementia was repeatedly observed over several days with facial hair on her chin and face and long, jagged fingernails, despite care plan interventions for partial to moderate assistance with personal hygiene and no documentation that she refused shaving.

A closed record review for another resident with non-traumatic subarachnoid hemorrhage and chronic respiratory failure showed that the resident, who required substantial to maximum assistance for bathing, did not consistently receive showers at least twice weekly. Facility shower documentation indicated missed showers on multiple scheduled days, with only intermittent showers and bed baths recorded during the admission period. Nurse’s notes referenced a shower and patient care on certain dates, but overall records showed gaps in providing the frequency of bathing consistent with the resident’s assessed needs and care plan interventions. Across these residents, the survey findings showed discrepancies between observed care and documented CNA task entries, as well as failures to carry out care plan interventions for ADLs, including shaving, nail care, showers, personal hygiene, and timely incontinence care, without documented refusals.