Failure to Provide Individualized ADL Care and Personal Hygiene
Penalty
Summary
The deficiency involves the facility’s failure to provide individualized ADL care, including repositioning, grooming, toileting, and bathing, in accordance with residents’ assessed needs and preferences. One resident with depression, anxiety, malnutrition, osteoporosis, and identified as at risk for pressure ulcers had an MDS indicating a need for supervision/touching assistance with turning and repositioning in bed. During a two-hour observation period, this resident remained lying on her back with the head of the bed slightly elevated, and no staff entered the room to assist or encourage her to turn or reposition. Another resident with diabetes mellitus and a hip fracture, who was cognitively intact, was observed lying in bed with long facial hair. He reported he had not been shaved in a long time and could not recall when he was last shaved, and stated that long facial hair made him feel dirty. A CNA stated residents were supposed to be shaved on admission, on shower days, or upon request, while another CNA reported that at times residents did not receive the care they deserved due to insufficient staffing and that residents were neglected. A third cognitively intact resident with a left tibia/fibula fracture, diabetes mellitus, and chronic kidney disease requiring dialysis was dependent on staff for bathing and required staff assistance for toileting. This resident reported having been left wet and soiled in urine and fecal matter for over two hours one morning, describing the experience as mortifying and nasty. She also reported not having received a shower during her two-week stay and that staff hardly got her up into a chair; at the time of observation, her hair was disheveled. Her documented preferences indicated it was very important to her to choose her bathing method and that she preferred showers, but her ADL care plan did not include bathing interventions. Review of her shower task list showed missed showers on multiple scheduled days, and a CNA confirmed she had not received any showers since admission, citing lack of shower sheets and frequent call-ins on scheduled shower days. These findings occurred despite facility policies stating that residents would be treated with dignity and receive necessary services to maintain grooming and personal hygiene.
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