| 3 |
KENTMERE REHABILITATION AND HEALTHCARE CENTER |
85001 |
1900 LOVERING AVENUE |
WILMINGTON |
DE |
19806 |
2016-07-18 |
312 |
E |
0 |
1 |
Z68211 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, interviews and review of facility documentation, it was determined that for 2 (R66 and R46) out of 30 Stage 2 sampled residents, the facility failed to ensure those residents, who were unable to carry out activities of daily living (ADLs), received the necessary services to maintain good grooming. For R66, the facility failed to ensure he maintained good grooming as evidenced by multiple observations of being unshaven and having jagged fingernails. In addition, the facility failed to ensure that R66 was bathed twice a week according to his plan of care. For R46, the facility failed to ensure fingernail cleanliness was maintained. Findings include: The facility policy entitled Bathing and Grooming, dated (MONTH) (YEAR), stated, To ensure that all residents are bathed, shaved, and receive fingernail care, as appropriate, to maintain cleanliness and a sense of well-being .Tub baths or showers are given by all nursing staff twice a week, or as necessary .Follow bathing schedule posted on each unit .Males and females, as appropriate, will have facial hair removed/shaved every other day .Finger nail care will be completed as scheduled, on the CNA assignment sheet . 1. Review of R66's clinical record revealed: R66 was readmitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 8/8/15, R66 was care planned for ADLs that included total assistance for bathing due to impaired cognition with an approach to provide a tub/shower two times a week and nail care. Review of R66's CNA documentation record regarding bathing revealed the following: May (YEAR) - bathed 4 out of 9 scheduled times; June (YEAR) - bathed 1 out of 9 scheduled times; and July 1 - 17, (YEAR) - bathed 0 out of 4 scheduled times. Review of R66's progress notes from (MONTH) 1, (YEAR) through (MONTH) 17, (YEAR) lacked evidence of R66 refusing bathing and/or grooming services. Observations of R66 included the following: - on 7/11/16 at 2:52 PM, observed unshaven with jagged fingernails. - on 7/13/16 at 4:34 PM, observed unshaven. - on 7/14/16 at 11:53 AM, observed unshaven with jagged fingernails. - on 7/15/16 at 11:43 AM, observed with jagged fingernails. This surveyor asked E5 (LPN, UM) to look at R66's fingernails. E5 immediately obtained nail clippers to trim R66's fingernails. - on 7/15/16 at 3:26 PM, observed unshaven. - on 7/18/16 at 9:19 AM, observed clean shaven. In an interview on 7/18/16 at 9:37 AM, E6 (CNA) stated that R66 was to be bathed on Mondays and Thursdays on the 11 PM to 7 AM shift. E6 stated that R66 requires total assist of one staff person for bathing, shaving and nail care. In an interview on 7/18/16 at 10 AM, findings were reviewed with E5 regarding multiple observations over 5 days of R66 being unshaven until today. E5 confirmed the finding after reviewing R66's clinical record and stated he was not aware of R66 not receiving scheduled showers since (MONTH) (YEAR). The facility failed to ensure that R66, a resident who is unable to carry out ADLs, received the necessary services to maintain good grooming, personal hygiene and bathing. Findings were reviewed with E2 (DON) on 7/18/16 at 10:08 AM. 2. Review of R46's clinical record revealed: R46's care plan for ADLs, effective 12/14/13, stated the resident was dependent for personal hygiene. An intervention included for staff to provide assistance for a daily sponge bath and twice weekly tub/shower and nail care. The 6/17/16 annual MDS assessment stated R46's cognitive skills for daily decision making were moderately impaired (decisions poor; cues/supervision required) and that R46 was totally dependent on one staff person for hygiene and bathing. Observations on 7/12/16 at 10:04 AM and 7/14/16 at 11:06 AM revealed R46 with dark colored debris under the fingernails of the left hand. In an interview on 7/14/16 at 11:07 AM, E7 (LPN) confirmed R46's left hand fingernails were dirty. E7 proceeded to clean R46's fingernails. The facility failed to provide R46, who was unable to carry out activities of daily living, the necessary services to maintain good grooming and personal hygiene. Findings were reviewed with E1 (NHA) and E2 on 7/18/16 at approximately 5:50 PM during the exit conference. |
2020-09-01 |