F0677

E

Failure to Provide Adequate ADL, Hygiene, and Grooming Assistance

Saint Louis, Missouri Survey Completed on 03-13-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide adequate activities of daily living (ADL) care, including toileting, bathing, and personal hygiene, to multiple residents. One resident with severe cognitive impairment, hemiplegia, and dependence on staff for toileting, bathing, dressing, and personal hygiene was observed in bed at midday with a strong urine and body odor. When CNAs turned the resident, the brief, two quilted bed pads, and fitted sheet were saturated with urine, and the resident had open wounds on both buttocks without dressings. A CNA reported last checking the resident around 8:00 A.M. and stated they did not want to disturb the resident due to sleep and frequent pain, while nursing staff and the DON stated incontinent residents were expected to be checked and repositioned every two hours.

Another resident, cognitively intact but with a history of stroke, dementia, diabetes, kidney failure, Parkinson’s disease, and myasthenia gravis, required partial to moderate assistance with bathing, personal hygiene, and toilet hygiene and was frequently incontinent of bladder and occasionally of stool. This resident was repeatedly observed in bed with strong body odor, uncombed oily hair, and an unshaven face with approximately half an inch of facial hair. The resident reported being willing to walk with a walker to the shower room but described the shower room as usually cluttered with equipment, which he could not move, and stated that staff did not help him get set up in the shower despite his requests. A CNA stated the resident “did his own thing,” was not known to need help with showers, and provided his own care, while the DON stated all residents required staff assistance with hygiene and were expected to be clean, dry, and odor free.

A third resident with severe cognitive impairment, type 2 diabetes, schizophrenia, and cerebral palsy had a care plan indicating an ADL self-care performance deficit and a need for maximum staff assistance with personal hygiene. The MAR showed an order for showers twice weekly on the evening shift, but two scheduled showers in the review month were not documented as given, and the resident was observed on two occasions with a strong sweat-like odor. Additionally, a cognitively intact resident with type 2 diabetes, hearing loss, and schizophrenia, care planned as dependent on staff for personal hygiene and oral care, was observed multiple times with long white curly hairs on the chin. This resident stated a desire to have the chin hairs removed. Nursing and CNA staff, as well as facility leadership, acknowledged that both CNAs and LPNs could assist with removal of unwanted facial hair and that staff should ask residents about grooming preferences, but this assistance had not been provided.