Failure to Provide ADL Assistance and Hygiene Care: A resident with stroke-related hemi-paralysis and aphasia was dependent on staff for all ADLs, including oral care and grooming. A CNA charted oral care and a warm washcloth but later said she documented in the wrong chart and did not provide those services. The resident was observed disheveled with unbrushed hair, dried eye discharge, and long nails with dirt underneath, and the spouse stated the resident had not received a warm washcloth or teeth brushing.
A resident with orthopedic aftercare and a skin infection was care planned for bed baths twice weekly, but CNA charting showed only one bed bath was provided during the review period with no refusals documented. Staff, including the unit manager and DNS, acknowledged the resident did not receive the scheduled showers or bed baths.
Failure to assist a resident with oral hygiene. A cognitively intact resident admitted with a fracture required ADL assistance, including oral hygiene, per MDS and care plan. The resident stated staff did not provide a toothbrush or offer help brushing teeth, and the toothbrush was later found still in its original wrapper by the sink. The assigned CNA confirmed oral care was not provided, and the DNS stated residents should be offered oral care twice daily.
A resident who needed assistance with ADLs and had an open wound and respiratory failure did not receive sufficient bathing after admission. The bathing log showed refusals, but there was no documented nursing follow-up or interventions, and staff interviews showed communication failures between CNAs and nursing about the refusals. The resident reported only one bath offer, no bathing for a week, and no follow-up after requesting bathing.
Failure to Provide Assistance With Personal Hygiene: A resident with Parkinson's disease and hand tremors required supervision, cueing, and assistance with shaving, but staff did not consistently offer or provide the needed help after showers. Observations showed the resident's beard was overgrown, and staff reported they either did not notice the need or did not have time to assist.
Inadequate Toileting Hygiene for a Dependent Resident: A cognitively intact resident who was incontinent of bowel and bladder and dependent on staff for perineal hygiene was found to have repeated episodes of feces left in the genital area after toileting care. The resident stated staff were not always thorough and did not feel fully clean, while multiple CNAs and an LPN reported observing inadequate hygiene and feces remaining after care; some concerns were not reported up the chain of command.
Failure to provide personal care for a resident who needed help with ADLs. A cognitively intact resident with schizophrenia and major depressive disorder had long, thick facial hair and stated a preference for short facial hair, but CNAs did not offer shaving or trimming since admission. Staff said shaving was typically offered on scheduled bathing days, and an LPN was unaware of the resident's grooming preferences.
Failure to provide fingernail care for a resident with DM and ESRD. The resident was cognitively intact, had long pointed fingernails with dark substance under them, and stated assistance was needed because of the DM diagnosis and that nail trimming had not been offered. The chart had no care plan direction for staff or an RN to trim the nails and no documentation that the task was completed; staff stated only an RN could perform the nail care for residents with DM.
Failure to Provide Adequate Nail Care: A resident who was cognitively impaired and dependent on staff for ADLs had dark, thick debris under the fingernails and around the cuticles on both hands over multiple observations. The care plan called for hygiene assistance, but the record lacked documentation of nail care, and staff, including CNAs, an LPN, and an RNCM, acknowledged the nails were dirty and that the resident needed assistance with hand washing and nail care.
Failure to provide hygiene and grooming care for a resident with hospice care and severe cognitive impairment. The resident needed substantial to maximum assistance with hygiene, but care documentation showed no bathing or nail care for an extended period. A family member observed poor oral hygiene, dirty fingernails, overgrown toenails, and foul-smelling feet, while a CNA acknowledged she had not completed all hygiene tasks and the RNCM could not explain why bathing or nail care were not provided.
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