A resident with dementia and severe cognitive impairment was inaccurately assessed and care planned as needing only setup or independent assistance with dressing, despite actually requiring total staff assistance. The EMR lacked clear ADL documentation, and the ADL CAA did not trigger, leading to inaccurate MDS entries and a care plan that did not match the resident’s functional status. Surveyors observed the resident sitting in a wheelchair wearing dirty, food-stained pants and being taken to the dining room without a clothing change, with the soiled pants not changed until later when two CNAs provided total assistance. Staff, including CNAs, an LN, and an administrative nurse, acknowledged that the resident needed total help with dressing and should always be in clean clothing, revealing a failure to provide appropriate ADL support and maintain clean attire.
The facility failed to provide consistent bathing and hygiene assistance to several cognitively intact but physically dependent residents whose EMRs and CAAs documented the need for staff support with ADLs and scheduled showers or baths, typically twice weekly. Over about a month, records showed that these residents received significantly fewer showers than scheduled, and observations noted greasy or unkempt hair, urine and body odors, and overgrown facial hair. Multiple residents reported not receiving showers as planned, sometimes going a week or longer without bathing and feeling dirty, smelly, neglected, or uncared for. A CMA reported that residents were not being bathed as they should be and were fortunate to receive a shower every ten days, attributing this to low staffing, while an administrative nurse acknowledged ongoing problems with completion of baths despite a facility policy requiring necessary services to maintain grooming and personal hygiene.
A resident with anxiety, DM, obesity, and dependence on staff for ADLs did not receive consistent bathing services as outlined in the care plan, which specified preferred shower days and times without any documented refusals for those scheduled showers. MDS assessments and monthly bathing records showed multiple extended periods with no baths or showers, while the EMR reflected only a few specific refusals that did not explain all missed bathing days. Staff reported the resident often refused baths and was offered washcloths and alternatives, but this was not consistently documented. During observed incontinence and personal care under Enhanced Barrier Precautions, staff noted a small open area under the resident’s abdominal pannus, and facility policy required provision of ADL care and documentation of refusals with alternative interventions, which was not consistently followed.
Surveyors found that several cognitively impaired, fully dependent residents did not receive basic ADL care, including shaving, nail care, face cleansing, and clean clothing. Residents were repeatedly observed with long facial whiskers, jagged and dirty fingernails, dried food on their faces, and soiled shirts, despite EMR, MDS, and care plans documenting the need for substantial to maximal staff assistance with personal hygiene. CNAs, an LPN, and administrative nursing staff all stated that residents were to be shaved on shower days, have nails trimmed and filed at least weekly, faces cleaned after meals, and clothing changed when dirty, but acknowledged these tasks did not always occur. These failures were inconsistent with the facility’s stated expectation and policy that residents be treated with dignity and respect.
The facility failed to provide consistent bathing and grooming for several residents who required assistance with ADLs. One resident with cognitive impairment went extended periods without documented baths or showers despite a care plan requiring assisted bathing, and was observed with stained clothing and chin hair. Another resident with intact cognition, who preferred twice-weekly showers and staff-assisted shaving, lacked documentation of receiving the requested showers, appeared unshaven, and reported not getting showers while being told he had refused, with no refusal forms available. A third resident with severe cognitive impairment and total dependence for personal hygiene was repeatedly observed with facial hair and dirty, jagged fingernails despite care plans directing staff to assist with grooming. Staff interviews revealed inconsistent practices and confusion over who was responsible for shaving and nail care, contrary to facility policy requiring necessary services to maintain residents’ grooming and personal hygiene.
A resident with a history of stroke and hemiplegia, cognitively intact and fully dependent on staff for ADLs including showering, did not receive scheduled showers as care-planned and listed on the shower schedule. Over a review period, only a portion of the scheduled showers were actually provided, with discrepancies between paper shower sheets and EMR task sign-offs. The resident reported not receiving her scheduled weekday showers for several weeks, stating she did not refuse care and was not offered a bed bath. CNAs and nursing staff described expectations to document all offered showers, baths, and refusals on shower sheets and in the EMR, but only a limited number of shower sheets could be located. Administrative nursing staff confirmed that the resident did not receive showers according to the established schedule, in conflict with the facility’s ADL policy requiring necessary services to maintain personal hygiene.
A resident with MS and severe cognitive impairment, who was dependent on staff for oral hygiene, did not consistently receive ordered and care-planned oral care. The care plan and provider orders required staff to assist with toothbrushing twice daily, and dental consults documented poor oral hygiene with heavy food debris and severe gum inflammation, along with instructions to remind and assist with brushing. Surveyors observed morning care without any oral care offered, and the resident’s toothbrush and toothpaste were found dry. The resident’s representative reported ongoing concerns about lack of oral care, an LN admitted signing off oral care without performing it, and a CNA stated she forgot to provide oral care that day, despite acknowledging the resident could not brush independently.
A resident with Alzheimer’s disease, depression, and impaired cognition who required staff assistance with ADLs was observed with greasy hair, several days of facial hair growth, and a shirt with dried food stains from a prior meal. Documentation showed the resident needed help with bathing, personal hygiene, and dressing and preferred daily shaving, yet bathing occurred only intermittently and the resident reported not remembering the last bath. Staff interviews confirmed expectations to offer showers, provide bed baths if refused, and change clothing and perform hygiene when residents appeared unclean, but these practices were not carried out for this resident, resulting in a failure to provide needed grooming, shaving, and clean clothing.
Several residents who were dependent on staff for ADL assistance did not receive regular bathing as required by their care plans, resulting in poor hygiene, soiled clothing, and strong odors. Staff interviews revealed challenges in completing scheduled baths, especially on shifts staffed by agency personnel who reportedly refused to perform bathing duties. Documentation confirmed infrequent bathing for these residents, contrary to facility policy.
A resident who was dependent on staff for all ADLs and received tube feeding was not provided with required mouth care, as observed by the presence of a thick yellow substance on her lips and in her mouth. Staff interviews revealed that while all nursing staff were responsible for resident hygiene, there was no documentation or clear accountability for providing oral care to residents with internal feedings, resulting in a failure to follow the care plan and facility policy.
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