Other·March 22, 2024

REGULATION VIOLATION(S) F677 – Activities of Daily Living §483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. The facility failed to ensure 20 of 24 residents, who were unable to carry out Activities of Daily Living (ADL) independently in the COVID Unit, received the necessary services to maintain good nutrition and personal hygiene. ADLs comprised: Eating, personal hygiene, toilet use, dressing and bathing. These failures affected the following residents: 1, 7, 11, 12, 13, 14, 15, 16, 17, 18, 21, 22, 23, 24, 26, 27, 29, 31, 33 and 36. These failures resulted in the residents not receiving baths or showers, and not being assisted with eating, toileting, and personal hygiene. For Resident 1, these failures resulted in Resident 1 feeling humiliated by having to wear adult briefs and having to soil herself instead of being assisted to the bathroom for bowel and bladder elimination. During the survey period, from 1/5/21 to 1/15/21, the Department received complaints that dependent residents were not being assisted with eating, were not receiving showers, incontinent residents were being left soiled for hours and not being cleaned, residents were not being toileted and assisted with personal hygiene. During observations of the COVID Unit on 1/5/21, 1/6/21 and 1/11/21, the unit smelled of urine and feces. During interviews with licensed nurses and CNAs working in the COVID Unit on 1/5/21, 1/6/21, 1/11/21 and 1/12/21, the nursing staff indicated there was insufficient staff to provide care to the residents in the COVID Unit. During an interview on 1/15/21, at 10:50 a.m., Certified Nursing Assistant I (CNA I) stated CNAs were responsible for assisting residents with Activities of Daily Living (ADLs). She stated CNAs documented care on the ADL flowsheets. RESIDENT 1 A review Resident 1's face sheet indicated she had diagnoses which included generalized muscle weakness. A review of Resident 1's Activities of Daily Living (ADL) Care Plan, date initiated 1/14/20, indicated the following interventions: DRESSING: - Assist the resident to choose simple comfortable clothing that enhances the resident's ability to dress self. - The resident requires (Extensive assistance) by (1) staff to dress; PERSONAL HYGIENE: - The resident requires (Extensive assistance) by (1) staff with personal hygiene and oral care; TOILET SCHEDULE: - Scheduled toileting: before breakfast, after getting up/morning, before lunch, before dinner, before bedtime, and per demand. A review of Resident 1's, "IDT Conference Sheet," undated, indicated Resident 1 was on a, "Scheduled Toileting Program." During an interview on 1/13/21, at 1:38 p.m., Licensed Nurse F reviewed Resident 1's, "IDT Conference Sheet," and indicated a, "Scheduled Toileting Program," meant a resident was supposed to be transferred from the bed to the toilet for bowel and bladder elimination, every two hours. During an observation and interview on 1/12/21, at 10:10 a.m., Resident 1 was observed in her room, lying in her bed, and wearing a gown. Resident 1 stated she used to go to the restroom for toileting, but facility staff told her she had to wear adult briefs and soil her herself and wait for staff to come change her because staff told her they do not have time to come and take her to the bathroom. She stated she accepted this because she had no other choice but felt humiliated by having to wear adult briefs and soil herself and wait to be changed. Resident 1 stated she wanted to be taken to the toilet for bowel and bladder elimination. Resident 1 also stated she wished she could wear her own clothes instead of a gown. Resident 1 stated: "Look, I have a closet full of clothes, but they make me wear these gowns because they said they do not have time to help me dress." She stated it was humiliating. An observation of her closet indicated Resident 1 possessed personal clothes. During an interview on 1/13/21, at 12:25 p.m., Resident 1's family stated Resident 1 was not receiving the care she needed. The family stated Resident 1 had been left soiled in urine several times, one time up to 5.5 hours, and Resident 1 felt terrible about it. The family stated the facility did not have enough staff to meet resident care needs. During an observation and interview on 1/14/21, at 6:05 a.m., Resident 1 was in her room, lying in her bed and wearing a gown. Resident 1 stated she had been soiled for hours, and no one had cleaned or changed her despite her asking for assistance. Resident 1 stated she had been wearing the same dirty gown for three days. Resident 1 stated she needed to use the toilet. Resident 1's call light was on. During an observation on 1/14/21, at 6:35 a.m., Certified Nursing Assistant (CNA) T arrived to assist Resident 1. CNA T removed Resident 1's soiled adult brief, cleaned her, and placed new adult briefs on her. RESIDENT 7 A review of Resident 7's face sheet and Interdisciplinary Team (IDT) report, dated 12/15/20, indicated Resident 7 was 78 years-old, had diagnoses including dementia and generalized muscle weakness, required extensive assistance with activities of daily living (ADL - eating, personal hygiene, toilet use, dressing and bathing), had multiple pressure ulcers, was incontinent of bowel and bladder, was on a toileting program (needed to be checked and changed every two hours) and was on a repositioning program (needed to be turned and repositioned every two hours), and was at risk for falls, dehydration and skin breakdown. A review of Resident 7's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Tuesdays and Fridays: No bathing provided to Resident 7 during the period of 1/3/21 to 1/12/21 (bathing missed on 1/5/21, 1/8/21, 1/12/21). ADL - Eating: Resident 7 not assisted/not done from 1/3/21 to 1/13/21. ADL - Personal Hygiene: Resident 7 not assisted/not done from 1/3/21 to 1/13/21. ADL - Toilet Use: Resident 7 not assisted/not done from 1/3/21 to 1/13/21. RESIDENT 11 A review of Resident 11's face sheet and IDT report, dated 7/16/20, indicated Resident 11 was 70 years-old, had a diagnosis of generalized muscle weakness, required extensive assistance with ADLs, was non-ambulatory, was incontinent of bowel and bladder, and was at risk for falls, dehydration, and skin breakdown. A review of Resident 11's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Wednesdays and Saturdays: No bathing provided to Resident 11 during the period of 1/2/21 to 1/12/21 (bathing missed on 1/2/21, 1/5/21, 1/9/21). ADL - Eating: Resident 11 not assisted/not done from 1/2/21 to 1/12/21. ADL - Personal Hygiene: Resident 11 not assisted/not done from 1/2/21 to 1/12/21. ADL - Toilet Use: Resident 11 not assisted/not done from 1/2/21 to 1/12/21. RESIDENT 12 A review of Resident 12's face sheet and IDT report, dated 7/20/20, indicated Resident 12 was 65 years-old, had a diagnosis of generalized muscle weakness and need for assistance with personal care, required extensive assistance with ADLs, was incontinent of bowel and bladder, and was at risk for falls, dehydration, and skin breakdown. A review of Resident 12's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Monday and Thursdays: No bathing provided to Resident 12 during the period of 1/1/21 to 1/12/21 (bathing missed on 1/4/21, 1/7/21, 1/11/21). ADL - Eating: Resident 12 not assisted/not done from 1/1/21 to 1/12/21. ADL - Personal Hygiene: Resident 12 not assisted/not done from 1/1/21 to 1/13/21. ADL - Toilet Use: Resident 12 not assisted/not done from 1/1/21 to 1/13/21. RESIDENT 13 A review of Resident 13's face sheet and IDT report, dated 7/02/20, indicated Resident 13 was 79 years-old, had a diagnosis of generalized muscle weakness and need for assistance with personal care, required extensive assistance with ADLs, was incontinent, and was at risk for falls, dehydration, and skin breakdown. A review of Resident 13's ADL flowsheets indicated the following non-compliance: Bathing (showers/Bed Bath) on Monday and Thursdays: No bathing provided to Resident 13 during the period of 1/1/21 to 1/6/21 (bathing missed on 1/4/21). ADL - Eating: Resident 13 not assisted/not done from 1/1/21 to 1/5/21. ADL - Personal Hygiene: Resident 13 not assisted/not done from 1/1/21 to 1/5/21. ADL - Toilet use: Resident 13 not assisted/not done from 1/1/21 to 1/5/21. RESIDENT 14 A review of Resident 14's face sheet and Baseline Care Plan, dated 12/17/20, indicated Resident 14 was 96 years-old, had a diagnosis of generalized muscle weakness, need for assistance with personal care, abnormalities of gait and mobility, required assistance for ADLs, required help with bed mobility, was incontinent of bowel and bladder and required assistance with bed mobility. During an observation on 1/6/21, at 9:05 a.m., Resident 14 was lying in sheets soaked in urine. A review of Resident 14's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Friday and Tuesdays: No bathing provided to Resident 14 during the period of 1/1/21 to 1/6/21 (bathing missed on 1/1/21 and 1/5/21). ADL - Eating: Resident 14 not assisted/not done from 1/1/21 to 1/6/21. ADL - Personal Hygiene: Resident 14 not assisted/not done from 1/1/21 to 1/6/21. ADL - Toilet Use: Resident 14 not assisted/not done from 1/1/21 to 1/6/21. RESIDENT 15 A review of Resident 15's face sheet and IDT report, dated 7/6/20, indicated Resident 15 was 55 years-old, had a diagnosis of generalized muscle weakness and need for assistance with personal care, required extensive assistance with ADLs, was at risk for falls, dehydration, and skin breakdown. A review of Resident 15's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Wednesdays and Saturdays: No bathing provided to Resident 15 during the period of 1/1/21 to 1/5/21 (bathing missed on 1/2/21). ADL - Eating: Resident 15 not assisted/not done from 1/1/21 to 1/5/21. ADL - Personal Hygiene: Resident 15 not assisted/not done from 1/1/21 to 1/5/21. ADL - Toilet Use: Resident 15 not assisted/not done from 1/1/21 to 1/5/21. RESIDENT 16 A review of Resident 16's face sheet and IDT report, dated 7/7/20, indicated Resident 16 was 92 years-old, had diagnoses of generalized muscle weakness and abnormalities of gait and balance, required extensive assistance with ADLs, was incontinent, and was at risk for falls and risk of skin breakdown. A review of Resident 16's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Tuesdays and Fridays: No bathing provided to Resident 16 during the period of 1/2/21 to 1/12/21 (bathing missed on 1/5/21, 1/8/21, and 1/12/21). ADL - Eating: Resident 16 not assisted/not done from 1/2/21 to 1/10/21. ADL - Personal Hygiene: Resident 16 not assisted/not done from 1/2/21 to 1/10/21. ADL - Toilet Use: Resident 16 not assisted/not done from 1/2/21 to 1/10/21. RESIDENT 17 A review of Resident 17's face sheet and Baseline Care Plan, dated 12/20/20, indicated Resident 17 was 72 years-old, had a diagnosis of generalized muscle weakness and need for assistance with personal care, needed assistance with ADLs and assistance with bed mobility and transfers. A review of Resident 17's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Tuesdays and Fridays: No bathing provided to Resident 17 during the period of 1/1/21 to 1/6/21 (bathing missed on 1/1/21 to 1/5/21). ADL - Eating: Resident 17 not assisted/not done from 1/1/21 to 1/6/21. ADL - Personal Hygiene: Resident 17 not assisted/not done from 1/1/21 to 1/6/21. ADL - Toilet Use: Resident 17 not assisted/not done from 1/1/21 to 1/6/21. RESIDENT 18 A review of Resident 18's Baseline Care Plan, dated 12/4/20, indicated Resident 18 was 88 years-old, had diagnoses which included abnormalities of gait and mobility, generalized muscle weakness, need for assistance with personal care, hemiplegia, falls, and required staff assistance for eating, dressing, personal hygiene, bathing, and toileting. A review of Resident 18's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Monday and Thursdays: No bathing provided to Resident 18 during the period of 1/1/21 to 1/12/20 (bathing missed on 1/4/21, 1/7/21, 1/11/21). ADL - Eating: Resident 18 not assisted/not done from 1/2/21 to 1/10/21. ADL - Personal Hygiene: Resident 18 not assisted/not done from 1/2/21 to 1/10/21. ADL - Toilet use: Resident 18 not assisted/not done from 1/2/21 to 1/10/21. During observations in the COVID-19 Unit I on 1/5/21, at 10:10 a.m., there was a strong smell of urine and feces in the hallway and in the rooms. Outside of one resident room, there was an open garbage bag hanging from the handrail filled with food containers and other trash. Next to it, on the floor, there was an open trash bag overflowing with used gowns. Soiled linen was also on the floor. The call light of this room was activated. Inside, Resident 18 was attempting to transfer herself from a wheelchair to the toilet. Resident 18 tried to pivot from the wheelchair to the toilet (which was dirty with feces), but her arms gave in, and she fell back into the wheelchair. No staff came to assist or supervise her. Resident 18 asked if the Department investigator could help her get to the toilet. Resident 18 also asked for water. Resident 18's breakfast container was untouched, as were the breakfast containers of her two roommates. RESIDENT 21 A review of Resident 21's face sheet and IDT report, dated 12/7/20, indicated Resident 21 was 85 years-old, had a diagnosis of generalized muscle weakness and need for assistance with personal care, had pressure ulcers, required extensive assistance with ADLs, was incontinent, and was at risk for falls, dehydration, and skin breakdown. A review of Resident 21's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Tuesdays and Friday: No bathing provided to Resident 21 during the period of 1/1/21 to 1/6/21 (bathing missed on 1/1/21, 1/5/21). ADL - Eating: Resident 21 not assisted/not done from 1/1/21 to 1/7/21. ADL - Personal Hygiene: Resident 21 not assisted/not done from 1/1/21 to 1/7/21. ADL - Toilet Use: Resident 21 not assisted/not done from 1/1/21 to 1/7/21. RESIDENT 22 A review of Resident 22's face sheet and IDT report, dated 6/15/20, indicated Resident 22 was 77 years-old, had a diagnosis of generalized muscle weakness; required extensive assistance with ADLs, was incontinent of bowel and bladder, was on turning and repositioning program, toileting program and was at risk for falls and skin breakdown. A review of Resident 22's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Tuesdays and Fridays: No bathing provided to Resident 22 during the period from 1/1/21 to 1/5/21 (bathing missed on 1/1/21 and 1/5/21). ADL - Eating: Resident 22 not assisted/not done from 1/1/21 to 1/5/21. ADL - Personal Hygiene: Resident 22 not assisted/not done from 1/1/21 to 1/5/21. ADL - Toilet Use: Resident 22 not assisted/not done from 1/1/21 to 1/5/21. RESIDENT 23 A review of Resident 23's face sheet and IDT report, dated 8/10/20, indicated Resident 23 was 66 years-old, had generalized muscle weakness and need for assistance with personal care, required extensive assistance with ADLs, was incontinent of urine and was at risk for falls and skin breakdown. During an observation on 1/6/21, at 9:10 a.m., Resident 23 stated: "I have tremors, I can't feed myself, I haven't had breakfast, please help me, no one helps me eat." A review of Resident 23's ADL flowsheets indicated the following non-compliance: Bathing (Showers/Bed Bath) on Wednesdays and Saturdays: No bathing provided to Resident 23 during the period from 1/4/21 to 1/10/21 (bathing missed on 1/6/21 and 1/9/21). ADL - Eating: Resident 23 not assisted/not done from 1/5/21 to 1/10/21. ADL - Personal Hy