Failure to provide ADL care and hygiene assistance: One resident with Parkinson’s disease, DM2, dysphagia, and polyneuropathy was scheduled for showers twice weekly but had no documented bath or shower for nearly two weeks and was observed with dirty clothing, skin flakes, messy hair, and facial stubble. Another resident with parkinsonism and Alzheimer’s disease, who required maximal assistance with personal hygiene, was repeatedly observed with dirty fingernails. Staff stated nails should be cleaned when dirty and checked daily, but the resident’s nails remained unclean.
A resident with dementia, impaired cognition, and frequent urine and bowel incontinence was left in a soiled brief and soiled bedding for an extended period despite a care plan directing regular toileting assistance and incontinence checks. Staff entered the room multiple times for meds, meals, and housekeeping but did not ask about toileting or change the brief until later, when the resident was found with urine and feces odor, bright red buttocks, and dried urine on the bedding.
Failure to provide ADL care for dependent residents with dementia resulted in three residents having long, jagged, dirty fingernails despite care plans and EMR task records showing they needed staff help with personal hygiene and nail care. Surveyors observed the residents in common areas, at meals, and in therapy with unclean nails, while staff said nail care was done on shower days or PRN and an admin nurse stated fingernails were expected to be kept smooth and clean at all times.
Failure to provide needed grooming and nail care: A resident with hemiplegia and impaired cognition was observed with dirty clothing, jagged nails, and chipped polish over several days; another resident with hemiplegia and severe cognitive impairment had chipped and worn-off nail polish and became upset when manicures were missed; and a third resident with Parkinson's disease and severe cognitive impairment was repeatedly observed with very long fingernails and stubbly facial hair. Staff interviews showed expectations for CNA, nursing, and activities involvement in nail care and facial hair removal, while the facility policy required residents unable to perform ADLs to receive necessary grooming services.
Failure to change soiled clothing: A resident with a stroke history, impaired cognition, and dependence for dressing was left in a dirty T-shirt with food debris and spilled fluids after being transferred to bed by an LN and CMA. The resident was later seen in the dining room still wearing the soiled shirt, and the CMA confirmed staff had not changed it even though clothes should be changed when dirty.
A resident with COPD, MDD, bladder dysfunction, and DM was dependent on staff for bathing and other ADLs, but bathing was not provided or documented as required. Records showed no bath sheets for an extended period, no refusal documentation, and the resident reported only one shower in two years, few bed baths, and inability to clean his hands or fingernails because his sink was not usable. Staff interviews showed confusion about bathing documentation and refusal handling, while observations found long fingernails with dark brown debris under them.
A resident with vascular dementia, self-care deficit, and MDD was dependent on staff for bathing and personal hygiene, yet the facility did not document or provide shaving assistance as part of routine grooming. Staff observed chin hair on the resident, and both the CNA and an administrative nurse confirmed shaving should be offered when needed and during bathing, but there was no evidence the resident had been offered help with shaving and the facility lacked a policy addressing shaving as part of ADL care.
Failure to assist a resident with ADLs and oral hygiene: A resident with dementia, severe cognitive impairment, and dependence for personal hygiene was repeatedly observed with a dried brown film on her lower lip while sitting in common areas and the dining room. Staff interviews showed confusion about whether the material was dried blood or related to a sore in her mouth, and an LN and administrative nurse stated staff should have wiped her lips, but this was not done.
A facility failed to ensure ADL assistance was provided for multiple residents who needed help with personal hygiene. One resident with dementia and severe cognitive impairment had repeated long facial hairs on her chin despite a care plan for staff assistance. Several other residents with cognitive impairment or other diagnoses were observed with long, dirty fingernails or dried-on debris under the nails, while staff said nail care and shaving were typically done on shower days. An admin nurse stated staff were expected to trim and smooth fingernails as needed, and the facility did not provide an ADL policy when requested.
Failure to provide consistent bathing assistance for dependent residents. Three residents with significant physical impairments and, for two of them, cognitive impairment, were dependent on staff for bathing or showering. Records showed missed or inconsistent bathing documentation, use of NA entries, and limited showers or baths despite scheduled preferences. On observation, residents had dirty hair, beard, and fingernails, and one resident stated she had not had a shower since admission and wanted one.
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