F0677

E

Failure to Provide and Document ADL and Hygiene Care for Multiple Dependent Residents

Grand Blanc, Michigan Survey Completed on 02-25-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide and document adequate ADL and hygiene care, including bathing, nail care, shaving, and personal hygiene, for multiple dependent residents. One resident with metabolic encephalopathy, dementia, muscle weakness, and difficulty walking had long, broken, and jagged fingernails and facial hair extending beyond the goatee style he preferred. His MDS showed moderately impaired cognition and a need for substantial to maximal assistance with bathing and dressing and partial to moderate assistance with personal hygiene. His shower schedule showed only three showers documented over a 30‑day period, and there was no documentation of nail care or refusals of nail care, nor any care plan focus addressing refusals of care.

Another resident with bilateral above‑knee amputations, diabetes, cognitive communicative deficit, and end‑stage renal disease on dialysis was observed in a room with a pervasive, rank odor that intensified near the resident. The resident required moderate to total assistance with ADLs and had a care plan calling for two‑person total assist for bathing. The bathing task record showed missed or undocumented scheduled baths and documented refusals on some days, but there was no progress note documentation of reapproach attempts after refusals or explanations for why bathing was not completed on specific dates. The DON attributed the odor to a recent UTI and stated the room would be cleaned, but the record showed only antibiotic courses and did not document hygiene interventions related to the odor.

A ventilator‑dependent resident with severe cognitive impairment and total dependence for ADLs was observed with long, dark chin hairs and dark, unknown material under the fingernails. The care plan addressed ADL self‑care deficits and nail trimming behavior but did not include any focus or intervention for chin hair care. Another ventilator‑dependent resident, fully dependent for ADLs, was observed with dry, cracked lips, dried substance around the mouth and cheek, brownish areas on pillow and blankets, and mucous in the corners of both eyes, with similar findings of dried and moist mucous around the mouth on a later observation. The DON acknowledged this lack of hygiene was not acceptable.

A resident with heart disease, oxygen dependence, stroke with dysphagia and aphasia, and right‑sided hemiplegia and hemiparalysis, who required moderate to total assistance for most ADLs, was observed with long, greasy hair containing visible chunks of an unknown substance and a long, unkempt beard, despite stating a preference to be shaved and an inability to shave independently. The resident’s right hand was flaccid and clenched in a fist, with long, unkempt fingernails digging into the palm, and the resident reported hand pain from the nails. The care plan called for extensive assist with personal hygiene but did not prevent this condition. Another resident with a history of cerebral infarction, cognitive communication deficit, and acute respiratory distress syndrome, requiring extensive assistance for personal hygiene, was observed with long fingernails. This resident reported disliking the nail length, stated they had asked staff to cut their nails without the request being fulfilled, and that staff did not offer nail care; the EMR contained no documentation of nail care being completed.

Across these residents, surveyors found repeated failures to provide scheduled bathing, nail trimming, shaving, and routine hygiene, as well as failures to document refusals and to incorporate refusals and specific grooming needs into care plans. Observations included offensive odors, visibly unclean or unkempt hair and beards, long and jagged fingernails (sometimes causing discomfort), dried secretions on the face, and soiled linens. The records lacked consistent documentation of ADL care completion, reasons for missed care, or follow‑up after refusals, demonstrating that the facility did not implement and operationalize procedures to ensure dependent residents received necessary ADL and hygiene care.