Failure to Provide Scheduled Bathing and Needed Nail Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide and document adequate ADL care, specifically bathing, for a resident who was dependent on staff for showers. One resident with Parkinson’s disease, type 2 diabetes mellitus, and spinal stenosis had an MDS showing intact cognition and dependence on staff for bathing, with a care schedule indicating showers on day shift on Wednesdays and Saturdays. Shower documentation for a specified month showed that the resident received showers on several listed dates, but there was no documentation of the resident receiving or refusing showers on three scheduled shower days. The DON confirmed there was no documented evidence that the resident received showers on those dates. The deficiency also includes failure to provide needed grooming care, specifically fingernail trimming, to another cognitively intact resident with type 2 diabetes mellitus, Raynaud’s syndrome, osteoarthritis, and self-care and mobility deficits requiring substantial/maximal assistance with toileting, personal hygiene, and bathing. A progress note documented that the resident refused a bath/shower on one date but allowed nail trimming at that time, with no further documentation of nail care. On observation, the resident’s fingernails were of varying lengths, with several extending about one and one-half inches beyond the nail tip and others jagged and shorter. The resident stated she did not like her nails that long, had asked staff to trim them, and was considering breaking them herself. A CNA confirmed the nails were long and jagged and stated nails are usually trimmed with showers and daily care. On a subsequent observation the next day, the resident’s nails remained untrimmed, and both the resident and the CNA confirmed that nail trimming still had not been done, despite the CNA having informed the assigned aide and nurse the previous day. Facility policy required appropriate support and assistance with hygiene, bathing, and grooming for residents unable to carry out ADLs independently.
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