F0677

E

Failure to Provide Adequate ADL Assistance With Hygiene, Feeding, and Clothing

Syracuse, New York Survey Completed on 03-10-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide necessary assistance with activities of daily living (ADLs), including grooming and personal hygiene, as required by its ADL Care policy and residents’ care plans. The policy, revised 06/2025, required morning and evening care based on residents’ assistance levels, including partial bathing, mouth care, hair combing, dressing, keeping fingernails and toenails clean and at appropriate length, ensuring females were free from facial hair unless they chose otherwise, providing meal setup and assistance as needed, and offering clothing choices or providing choices if residents were unable. Despite these requirements, surveyors identified multiple instances where residents did not receive the planned ADL support.

One resident with kidney failure and atrial fibrillation, cognitively intact and requiring partial/moderate assistance with personal hygiene and total assistance for bathing, was observed repeatedly over several days with multiple patches of white and gray facial hair on the upper lip, chin, and neck, and with long fingernails containing dark brown debris under all five nails on the right hand. The resident stated they did not want hair on their face and reported that staff did not offer to shave them even after morning care. A CNA who regularly cared for this resident acknowledged noticing the facial hair but stated they were too busy to shave the resident and were unsure about trimming nails, though they could clean them. Nursing staff, including an LPN and the Assistant DON, confirmed that personal hygiene included shaving and nail care and should be completed daily by CNAs, with nurses responsible for trimming diabetic residents’ nails, but they either had not noticed or were unaware of the resident’s long, dirty fingernails.

Another resident with dementia and depression, with severe cognitive impairment and requiring substantial to maximal assistance with eating, was care planned for maximum assistance with a mechanically soft diet. Observations during multiple noon meals showed the resident seated at a table, often asleep, with meal trays provided but with inconsistent and interrupted assistance from CNAs and an LPN. Staff would begin assisting, then leave to help other residents, and at times did not attempt to wake or encourage the resident to eat, resulting in significant portions of food and beverages remaining untouched before the resident was removed from the table. A third resident with dementia, depression, and anxiety, severely cognitively impaired and dependent on staff for most ADLs including dressing, was observed on multiple occasions wearing visibly soiled clothing with white and brown substances on the front of their pants and shirt. Staff interviews confirmed this resident was dependent on staff for care, including clothing changes when soiled, and that assigned staff were responsible for ensuring clothing was clean, while the unit manager and DON stated residents should not wear soiled clothing and expected staff to change visibly soiled garments.