F0677

D

Failure to Provide Required ADL Assistance With Hearing Devices, Meals, and Incontinence Care

Fairlawn, Ohio Survey Completed on 03-02-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide adequate assistance with activities of daily living (ADLs), including hearing aid management and meal setup, for a dependent resident. One resident with pulmonary fibrosis, hemiplegia and hemiparesis, and type 2 diabetes had an MDS indicating no cognitive impairment but a need for supervision or touching assistance with eating and some assistance with ADLs. Audiology consultations documented that this resident used hearing aids or amplifiers in both ears and could not hear a whisper test, while the facility’s hearing, speech, and vision assessment inaccurately recorded that her hearing was adequate and that she used no hearing devices. Her care plan addressed an ADL self-care performance deficit and assistance with care but did not include any interventions related to hearing devices, and there were no current physician orders addressing hearing devices despite an earlier order for audiology services.

On the morning of observation, the resident was found seated in a recliner with an untouched breakfast tray containing sealed containers, an unmade bed, and was visibly upset while struggling to insert both hearing aids. She reported that staff did not get her up at her requested time, that her shower and dressing were rushed, her bed was not made, and no one assisted her with opening her breakfast containers or inserting her hearing aids, which she stated were difficult for her to manage. An RN confirmed that the resident preferred to get up before breakfast and required help with meal setup and hearing aids, and that CNAs or nurses were responsible for assisting with the hearing devices, which were monitored via the resident’s phone. During a subsequent observation, the RN had to assist the resident with both her hearing aids and breakfast tray after the resident stated she had been trying unsuccessfully for ten minutes to insert the hearing aids and needed help opening her food.

The CNA who had provided the resident’s morning care acknowledged that she had assisted with morning care but did not help with hearing aids, did not make the bed, and did not assist with the breakfast tray, explaining that she did not usually work with this resident, even though she stated that information on residents’ care needs was available when assignments changed. Another RN later confirmed that the resident’s hearing aids were linked to her phone, that staff were responsible for assisting with the devices and keeping them charged, and that the resident required more assistance with ADLs due to a decline in health. These observations and interviews show that the resident, who was dependent on staff for certain ADLs and hearing aid management, did not receive the necessary assistance with hearing devices, meal setup, and basic morning care.

The deficiency also involves the facility’s failure to provide needed assistance with toileting and incontinence care for another dependent resident with cerebral infarction, lumbar disc displacement, and left-sided hemiplegia and hemiparesis. This resident’s MDS and care plan documented no cognitive impairment but a need for staff assistance with ADLs including toileting, lower body dressing, sit-to-stand, and toilet transfers, as well as mixed bladder incontinence and frequent bowel incontinence. Physician orders and therapy notes indicated the resident required staff assistance for transfers, was dependent for toileting and hygiene, and needed moderate assistance with toilet transfers. Progress notes documented that the resident had previously been found on the floor after his left leg gave out, and that he was educated and encouraged to ask for staff assistance due to ongoing weakness after a cerebrovascular accident.

An SRI documented the resident’s allegation that a CNA was neglectful after he requested assistance with incontinence care via the call light; he reported that the CNA questioned why he could not wait until the next shift, provided briefs, but did not assist with care. A later progress note recorded that the resident was found on the floor after attempting to clean himself following a bowel movement, stating he fell due to his bad leg, and that he required assistance from two staff with a gait belt to be transferred from the floor and then needed help donning a clean brief and sweatpants. The resident’s friend reported that a CNA treated the resident rudely, threw a pack of briefs at him, did not offer help, and asked why he could not wait until the next shift. The CNA involved confirmed that the resident required assistance with incontinence care, that she provided a pack of briefs when he said he needed to go to the bathroom, left the room without assisting him, and returned an hour later to find him visibly upset after a bowel incontinence episode, acknowledging she knew he required assistance but did not provide it because he did not explicitly ask for help.

In interviews, facility leadership acknowledged that the resident’s concerns about not receiving incontinence care were brought forward and that the resident had requested assistance, a CNA had given him briefs and left, and that the CNA believed the resident could provide his own care despite the medical record indicating he needed assistance. They confirmed that the resident required assistance and was not provided with incontinence care. The facility’s ADL Care Policy stated that individualized, person-centered assistance with ADLs, including essential self-care tasks, assessments, and care planning, was to be provided to all residents. The documented events, interviews, and record reviews show that for both residents, staff did not follow the documented ADL needs and did not provide the necessary assistance with ADLs, including hearing aid management, meal setup, toileting, and incontinence care.