Failure to provide daily ambulation assistance after therapy discharge. A resident who had been discharged from PT with orders for daily walking with nursing assistance and a RW was documented as walking only once over three months. Staff interviews confirmed nursing staff were expected to assist with daily ambulation, but CNAs reported they did not regularly walk the resident and had not seen her walk.
Failure to provide needed nail care: A resident who was dependent for ADLs stated her nails needed to be cut, and staff observed the nails to be long and in need of filing on repeated checks. The DON said Activities usually provided nail care and confirmed that this care should have been provided, but did not confirm the nails had been trimmed until a later observation showed them appearing trimmed and filed.
Failure to provide feeding assistance to dependent residents. A resident was observed with a cold breakfast tray and no feeding help despite a tray ticket showing assist needed, an LPN confirmed another resident had not been assisted and believed the order was old, and a third resident was found with a full lunch tray at bedside with no help provided. The resident’s daughter reported repeated instances of breakfast trays left untouched and cold, and the care plan called for partial/moderate assist with eating.
A resident who ate slowly and was observed falling asleep during lunch did not receive cueing or meal assistance while staff removed the tray after partial intake. Staff interviews confirmed aides typically left the tray because the resident took a long time to eat, and the DON acknowledged the resident did not receive meal assistance and had experienced weight loss.
A resident who preferred help with shaving was observed with visible facial hair and stated she does not always receive this assistance. The DON confirmed the resident had visible facial hair and said staff would help her get shaved.
Failure to provide needed ADL hygiene and bathing care for two residents. One resident was observed with a dirty face, neck, and hands, soiled bedding, long untrimmed fingernails, and scratches behind the ear, while the resident’s wife reported she had to clean him and trim his nails. Another resident stated he had gone several days without a shower, and records showed only one bed bath with no refusals despite a shower schedule and a care plan for extensive assist with bathing.
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.
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