Failure to Provide Basic ADL Hygiene and Grooming for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate activities of daily living (ADL) care, including shaving, nail care, face cleansing, and clothing hygiene, for multiple residents who were cognitively impaired and dependent on staff. One resident with dementia, documented as requiring substantial to maximal assistance with personal hygiene on the MDS, CAA, care plan, and EMR, was repeatedly observed on multiple days with long facial whiskers. CNAs and a licensed nurse stated that residents were supposed to be shaved on shower days, but acknowledged that this did not always occur. Administrative nursing staff also stated residents were to be shaved on shower days and as needed, consistent with the facility’s policy that residents have the right to be treated with dignity and respect. Another resident with severe cognitive impairment and dependent on staff for personal hygiene had a care plan directing staff to trim her fingernails weekly. She was observed on consecutive days sitting in a recliner with jagged, dirty fingernails. CNAs, a licensed nurse, and an administrative nurse all stated that residents’ fingernails were to be kept clean, smooth, and trimmed at least weekly, confirming that the observed condition did not meet facility expectations. The same facility policy on resident rights and dignity applied to this resident’s care. Additional residents with dementia or Alzheimer’s disease, all with MDS and care plan documentation showing moderate to severe cognitive impairment and dependence on staff for ADLs and personal hygiene, were observed with unshaven faces, dirty clothing, jagged and dirty fingernails, and dried food on the face. One resident was seen twice in the same day with an unshaven face and dried-on food debris on the front of his t-shirt, and another was observed on two days unshaven with jagged, dirty fingernails and dried food on his face around his mouth. Staff interviews confirmed that residents were supposed to be shaved on shower days, have their clothes changed when dirty, have their fingernails trimmed and filed weekly, and have their faces cleaned after meals as needed, but staff acknowledged these tasks did not always get done. These observations and statements show the facility did not follow its own care expectations and resident rights policy regarding dignity and respect.
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