Failure to Provide Required ADL Assistance With Oral Care and Morning Transfers
Penalty
Summary
The deficiency involves the facility’s failure to provide required assistance with activities of daily living (ADLs), specifically oral hygiene and getting out of bed, for dependent residents. One resident with impaired cognition and a documented self-care deficit in ADLs was care planned to receive daily and as-needed oral hygiene, yet ADL records for the prior 30 days showed oral care was provided on average only once per day. Another resident with cerebral infarction, diabetes, peripheral vascular disease, and intact cognition was care planned to receive mouth care and hygiene at least twice daily and as needed due to potential discomfort related to dentures, but ADL records likewise showed oral care was provided on average only once per day. Both residents, who shared a room, stated staff did not assist or prompt them to brush their teeth, and a CNA confirmed oral care was not provided daily, citing denture-related discomfort for one resident. An RN verified the lack of oral hygiene for both residents, despite a facility policy stating that ADL care and services, including oral care, would be provided. The deficiency also includes failure to assist another dependent resident with ADLs related to getting out of bed and dressing. This resident had diagnoses including atherosclerotic heart disease and chronic congestive heart failure, impaired cognition, bilateral lower extremity impairment, and physician orders and a care plan requiring a mechanical lift with two CNAs for all transfers. During observation and interview, the resident was found lying in bed, stating he had been in bed all morning waiting for staff to get him up, dressed, and transferred to his wheelchair, and that he preferred to be dressed before breakfast. A CNA confirmed the resident preferred to be out of bed before eating but stated that residents who required two staff and a mechanical lift had to wait if other staff were busy, and that this resident had already eaten breakfast and was still waiting in bed to get up. These findings were confirmed at the time of the interview and were investigated under a complaint number.
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