Failure to provide nail care was identified when several residents were observed with long, jagged, unkept fingernails and stated they wanted them trimmed or shorter. The facility's nail care policy required nails to be kept short and smooth and to be routinely cleaned and inspected during ADL care, but the DON offered no further comment when the findings were reported. In a separate finding, an offensive odor was noted coming from one resident's room, which the DON associated with a yeast infection; the resident later received a shower and had orders for Diflucan and topical Nystatin/Nystop.
Failure to provide needed grooming assistance: A resident reported that staff had not recently shaved unwanted facial hair on her chin, despite her preference for it to be done. The surveyor observed visible chin hair, and the Administrator acknowledged the issue. The facility policy stated residents unable to perform ADLs independently would receive services necessary to maintain grooming and personal hygiene.
Failure to provide ADL care for dependent residents. Two residents did not receive needed bathing or nail care: one resident had documented gaps in showers and bed baths over multiple days, and another resident was observed with long fingernails and limited ROM, with OT and the DON confirming the nails needed trimming.
Failure to Provide ADL Care During Meal Times: A resident who was totally dependent for toileting hygiene reported being told to wait until after supper to have a brief changed. During a Resident Council meeting, residents said they were being told to wait until after meals to be changed or taken to the restroom, and the DON acknowledged staff were not providing ADL care during meal times.
A resident who preferred to be clean-shaven did not receive needed assistance with shaving after his electric razor broke. He told staff and the surveyor that he wanted help, but he remained unshaven over several days and stated no one had asked to assist him. The DON confirmed the resident had not been shaved in at least three days.
Surveyors found that staff failed to provide and accurately document ADL assistance for multiple residents, including oral hygiene and scheduled showers. One resident’s oral care was marked as “not applicable” without any indication of refusal, and another resident had severe dental plaque despite a care plan requiring twice-daily teeth brushing. The DON acknowledged that staff were using “not applicable” instead of documenting refusals. A resident with Dementia and Parkinson’s Disease, who depended on staff for ADLs and preferred showers, was scheduled for twice-weekly showers but received only a few showers and bed baths over a month, with several missed showers recorded as “not applicable.”
Failure to Provide Timely ADL Care: A dependent resident was observed yelling out while in a room with a strong urine odor. The resident was found soiled and wet, with dried brown rings on the fitted sheet. An LPN stated she did not know when the resident had last been changed, and the DON later confirmed the resident should have been changed sooner.
A resident who was totally dependent for feeding was repeatedly left with meals in front of him without staff assistance, and he had to ask for help while struggling to eat lunch and a nutritional supplement. Another resident who was totally dependent for bathing and preferred showers twice weekly did not have documentation showing the required shower frequency, and the record did not show refusals for the missed showers.
Three residents did not receive scheduled showers or adequate assistance with ADLs as documented in their care plans, with staff and resident interviews confirming missed care and lack of refusals. The DON verified that documentation did not support that showers were provided as scheduled.
Several residents dependent on staff for ADL care experienced significant delays in receiving incontinence care and hygiene assistance, often waiting over an hour for help. Residents and observations indicated that call lights were frequently left unanswered, and staff shortages led to prolonged periods where residents remained soiled or unassisted, despite care plans documenting their need for substantial or maximal assistance.
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