SLIDE 13 August 2018 www.proactivemedicalreview.com 13
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F677 Harm Level Citation Example - OH
- Facility failed to ensure residents who required assistance for activities of daily living
received timely and necessary care to maintain adequate personal care and hygiene. Actual harm occurred to Resident when State tested Nursing Assistant (STNA) entered Resident's room, found the resident crying and upset and identified the resident had a large amount of stool that was dried to her skin. The resident's buttocks were observed to be red and starting to open. Resident informed STNA she had not been checked on by staff all night. – The resident stated she was aware of when she needed to use the bathroom to move her bowels. The resident stated a few days prior she had to move her bowels and was unable to activate her call light due to the placement of the call light and the light being wrapped around her right arm. The resident stated the door to her room was closed and since she was unable to reach her call light, she started to yell out. She stated she waited and waited, however, no staff came. The resident stated because no one came, she laid in feces all night. The resident stated this caused her skin to breakdown and she was very sore. The resident said she told her husband, when he came in that morning and he immediately shared the concerns with the Administrator. Further interview revealed by the time she was discovered the following morning, she was crying and upset because she felt scared and felt no one was there to care for her. (NHA submitted self report for allegation of neglect) – Other areas noted in citation were residents not provided assistance with oral care as needed, baths not documented as completed per care plans, dirty finger nails, & facial hair
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F677 Harm Citation Example - CO
- Facility failed to ensure one resident received the care and services
with bathing she was assessed to need and ordered to receive to maintain good grooming and personal hygiene. Specifically, for a number of months, the facility failed to provide the resident showers three times a week as ordered as well as the assistance she was assessed to need when she was showered. These failures contributed to resident odors, the resident's nonparticipation in facility activities and feelings of embarrassment, shame, depersonalization, and self-disgust.
– Care plan did not document guidance on her preferences or need for assistance for showers. (she required extensive assist with bathing) – Resident stated staff do not offer or assist her with shower 3X per week & bathing records showed less than one shower occurring weekly.
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F677 Harm Citation Example - WA
- Facility failed to ensure 1 resident received the necessary care and services to maintain
good oral hygiene. The failed practice cause harm to Resident who experienced significant plaque build-up, bleeding gums and oral pain. – Resident with developmental delay diagnosis & severe cognitive impairment – Care plan directed staff to set the resident up twice daily and as needed for oral care (12/17) & was updated in past 2 weeks (01/18) to indicated required physical assist of one with brushing teeth – Had poor oral care documented by the dentist at each visit over the course of the past year (6/17 & 10/17, 1/18). The assessment stated the resident had a broken bridge, and the dentist would not replace the bridge until the resident could show good oral care. Resident dislikes missing teeth very much and does want the bridge replaced . The assessment concluded the nursing staff would have more success if they were taught strategies specific for Resident and if the staff was aware of the severity of the resident's oral concerns. Dentist ordered brushing 2X day & swish & spit at each visit. – Guardian expressed concerns regarding oral care at multiple care conferences and felt staff did not
- address. Also when she asked staff to show bottle of medication ordered to swish & spit, it was still
full. – The behavior assessor identified how important the bridge was to the resident. The facility failed to implement the behavior assessors plan or participate in training to improve the resident's oral care.
