Two residents who depended on staff for personal hygiene were left with unwanted facial hair despite facility policy stating grooming includes shaving and removal of facial hair. Staff confirmed CNAs were responsible for addressing facial hair during shower time, and both residents were observed with chin hairs; one resident with severe cognitive impairment said she wanted them shaved, and the other said the hair bothered her and made her feel like an odd ball.
Failure to provide ADL grooming and oral care: surveyors observed one resident with long facial hair, another with long jagged fingernails, and a third with long jagged fingernails plus poor oral hygiene with blackened, deteriorated teeth and buildup along the gum line. An LPN, CNA, and DON confirmed the conditions, and records showed the residents had significant medical and cognitive impairments, including cerebral infarction, severe protein-calorie malnutrition, MS, hemiplegia, metabolic encephalopathy, and BIMS scores indicating moderate impairment.
Failure to Maintain Personal Hygiene Through ADL Care: A resident with Alzheimer's disease had fingernails that were observed to be about one inch long, jagged, and dirty underneath on multiple occasions. An LPN confirmed the nails should have been trimmed during bathing or showering, and the DON stated all residents' fingernails should be kept trimmed and clean.
Failure to Provide Oral Care: A resident who was dependent on staff for oral care was observed with dry, cracked lips, thick secretions, and coated teeth and tongue. Although aides were responsible for oral hygiene, the task record did not document oral care during the shift reviewed, and a CNA said care had been done earlier while an LPN said it was not completed appropriately. The DON confirmed oral care was part of aide-provided personal hygiene.
Failure to provide ADL assistance for two residents included missed bathing and personal hygiene care. One resident with hemiplegia had oily hair, facial hair, and reported going more than a week without a bath or hair care, while another cognitively intact resident with paraplegia had visibly oily hair and reported long gaps between showers. The DON and ADON confirmed residents were expected to be bathed on scheduled bath days and that showers should occur 3 times per week unless declined.
A resident with heart failure, chronic kidney disease, hypertension, moderate cognitive impairment, and total dependence on staff for personal and toilet hygiene reported difficulty obtaining assistance with ADLs. Observation revealed the resident had ten long, dirty fingernails extending several millimeters beyond the fingertips with black material underneath, and the resident stated they needed cleaning and cutting. An LPN confirmed the nails were too long and dirty, acknowledged that nursing staff were responsible for daily and weekly fingernail checks and for providing fingernail care as part of ADLs, and noted that such nails could cause skin damage or scratches. The DON and Administrator both confirmed that personal hygiene and grooming are part of ADLs and are expected to be provided for all residents dependent on staff.
Failure to Provide Timely ADL Assistance and Nail Care: Two residents had unmet ADL needs. One resident with hemiplegia and hemiparesis following CVA had long, jagged, dirty fingernails despite stating a preference for them to be trimmed, and the DON confirmed nail care was not provided. Another resident with CVA and intact cognition requested a bedpan but was left waiting while meal trays were passed; CNA assistance was delayed for about an hour, and RN, DON, and ADON confirmed the toileting delay was inappropriate.
Failure to Provide Hair Care and Shampooing Assistance: Two residents who depended on staff for ADL care were observed with unclean, matted, and tangled hair, and one had a foul odor. Staff and the Administrator confirmed the hair had not been washed, despite facility policy and routine bathing expectations. Both residents had severe cognitive impairment and diagnoses including dementia-related conditions.
A resident who was cognitively intact but fully dependent on staff for ADLs, including incontinence care, was observed lying in bed with fecal matter smeared on the bed pad and sheets after a bowel movement. The resident reported having been in a soiled brief for over an hour and expressed embarrassment and distress. After the resident activated the call light, a staff member entered only to deactivate it and leave without providing care. The resident’s representative later found the resident still soiled, notified staff at the nursing desk, and observed a nurse enter and then leave after texting a CNA. The CNA acknowledged being notified by an LPN that the resident needed changing but prioritized passing lunch trays and feeding another resident instead of providing incontinence care or seeking assistance. The resident remained in the soiled brief until the CNA finally entered with supplies nearly two hours after the initial observation.
Failure to provide ADL assistance with toenail care for a resident who required extensive ADL help. Staff observed the resident’s toenails to be thick, long, curved, and excessive in length, while the resident said they needed to be cut and was willing to see a podiatrist. CNAs reported they were expected to notify nursing of nail care needs, but no concerns had been reported, and the DON stated an earlier attempt to file the nails was refused with no follow-up completed.
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