Failure to provide adequate ADL and hygiene assistance for a resident with severe physical and cognitive impairments. The resident was dependent on staff for bathing and other ADLs, yet was observed with greasy, debris-filled hair, debris in his beard and around his mouth, dried food on his shirt, and wet pants in the groin area. The resident said he had only had one shower since admission and had to give himself bed baths, while staff reported he mostly received bed baths and only showered occasionally.
Failure to provide nail care for a resident with DM and vascular dementia. The resident had moderately impaired cognition, was totally dependent for toileting and personal hygiene, and his care plan directed staff to trim his nails as needed. Staff reported nail care was expected on bath days and when needed, but the resident’s fingernails were observed repeatedly to be long with brown substance under them, and records did not show that he refused nail care.
Failure to Provide Required Oral Care: A resident with quadriplegia, cognitive impairment, respiratory failure, and dependence on staff for all ADLs was supposed to receive oral care twice daily and as needed, but staff did not provide it. Observation showed thick grey mucus in the resident’s mouth, and later blood was seen around the lips and in the mouth. An LN and an Administrative Nurse performed a G-tube feeding demonstration without giving oral care, and the Administrative Nurse later confirmed oral care should have been completed that morning.
Failure to provide ADL assistance and nail care for two residents. One resident with anxiety and DM, intact cognition, and high assistance needs was observed with long fingernails and chipped nail polish that remained unchanged. Another resident with DM and severely impaired cognition was also observed with long, dirty nails and chipped polish. Staff reported nail trimming and manicures were inconsistent, and the care plan lacked clear direction for one resident's nail care needs.
A resident who was dependent on staff for all ADLs did not receive needed personal hygiene and grooming assistance. The resident had severe cognitive impairment, CP, epilepsy, respiratory failure, seborrheic dermatitis, and dysphagia, and the care plan directed total assistance with personal hygiene and oral care, but it did not address daily face washing, cocoa butter application, or nail trimming. Bath records showed only five baths during the stay, progress notes lacked documentation of facial care or nail care, and the resident was admitted to the hospital with very long fingernails. Staff interviews showed uncertainty about who was responsible for trimming nails, while the resident’s representative reported repeated requests for face washing, cocoa butter, and nail trimming.
Failure to Provide ADL Assistance: A resident with Parkinsons disease, dysphasia, depression, and severe protein calorie malnutrition was observed unshaven, uncombed, without socks or shoes, and wearing a shirt soiled with dried sputum. His G-tube was unsecured, drool hung from his mouth, and he coughed up thick yellow sputum. Although the care plan called for staff help with bathing, personal hygiene, dressing, oral care, and grooming, staff statements and observations showed he was not receiving the needed shaving and grooming assistance.
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.
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