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32 | Staff does not ensure resident’s hygiene needs are being met, the investigation revealed the following:
On March 19, 2012, R1 was admitted to the facility and into hospice on October 20, 2021, due to a progressing terminal illness of Myasthenia Gravis (MG) without Acute Exacerbation. R1 passed away on February 23, 2023, per Death Report dated March 1, 2023. R1 developed multiple pressure injuries with the first wound onset at stage 2 affecting the coccyx on September 13, 2022, per medical records. Per Title 22, 87631 Healing Wounds, regulation states that a physician or an appropriately skilled professional provides care to a resident with a stage one or two pressure injury. Based on the review of the medical records, wound care was treated by hospice. Based on the interviews, R1 did not corroborate with the allegation indicating that the pressure wound was expected due to R1 being “off their feet for 4-5 years.” R1 expressed receiving good care and confirmed receiving diaper changes 2-3 times and as needed by facility staff. Three out of the four facility staff denied the allegation stating R1’s diaper was changed at least 2-3 times per shift and more. The remaining staff could not provide information regarding R1’s care as they were not assigned to work with R1. Based on the review of the Physician’s Report dated May 17, 2018, R1 was able to care for their own toileting needs and does not require continuous bed care. Resident Assessment dated December 28, 2022, reveals R1 requiring a standby assist with toileting. It appears that the facility did not have a procedure to document diaper changes for all residents. Hospice staff indicated during the interview R1 declined for increased care due to additional cost.
Based on LPA’s observation of R1 during the visit conducted on December 28, 2022, R1 was alert and oriented, sitting upright in bed, and having their breakfast at 11:45am. The lunch tray was delivered approximately 12:10pm. LPA observed R1 was able to carry a conversation while independently having their meal which aligns with the findings on the Physician’s Report and on the Resident Assessment. Based on the interviews, three out of the four staff indicated that meals were delivered timely and R1 being able to feed self independently. R1’s primary caregiver indicated that food would be reheated as needed when R1 did not have an appetite. LPA observed the medications in R1’s room. Based on LPA’s observations, R1 demonstrated understanding the need for their medications, time, and quantity. R1 indicated that they manage their own medications. Per Physician’s Report and Resident Assessment, R1 self-administers their own meds also corroborated by three out of the four staff. Regarding hygiene care, R1 received showers from a hospice staff twice a week as noted on the Resident Assessment. R1 confirmed receiving showers every Tuesdays and Fridays and sponge baths by facility staff. Three out of the four staff denied the allegation. R1’s primary caregiver indicated that sponge baths were provided daily.
[Continued on LIC9099-C] |