Victoria Home

Based on observation, interview and record review, a resident who required assistance to perform his activities of daily living was not provided care to maintain good grooming and oral hygiene in a manner that was consistent with his personal wishes. This was evident for one of thirty-eight residents reviewed for personal hygiene and resulted in the potential for more than minimal harm that is not immediate jeopardy (Resident #16).

The findings are:

Resident #16 has diagnoses including Parkinson's Disease, Schizophrenia, heart and respiratory diseases. The resident has resided at the facility on a long term basis. He was hospitalized and readmitted to the facility on 4/27/11.

The resident was observed from 4/27/11 - 5/3/11 following his readmission and a comprehensive MDS (Minimum Data Set) assessment for a significant change in the resident's status was done. According to the MDS, the resident was usually understood when communicating and required the extensive assistance of one person with his personal hygiene, including brushing his teeth and shaving.

The resident was observed numerous times over a four day period including at 12:10PM on 7/11/11, 9:00AM on 7/12/11, 3:00PM on 7/13/11 and 11:30AM on 7/14/11. He was not clean shaven and was noted to have visible food debris between and on the surfaces of his teeth at those times.

The Licensed Practical Nurse (LPN) who works the day and the night shift was interviewed at 12:40PM on 7/14/11. The LPN stated that the resident is accustomed to do things a certain way and that he needs to have things done in that certain way to be comfortable. The LPN stated that the resident used to be independent in performing his personal hygiene and that it was very important for him to be well groomed. The LPN stated that he always dressed meticulously and paid attention to keeping his hair combed, face shaved and teeth brushed. She stated that he always brushed his teeth himself after every meal.

The day shift CNA was interviewed at 9:25AM on 7/14/11 regarding the assistance provided to the resident to clean his teeth. The CNA stated that, when the resident was more independent, he brushed his teeth after every meal because that was his routine and it was very important for him. The CNA stated that, the resident can still brush his teeth and rinse his mouth himself if she takes him to the sink and sets up his supplies. The CNA further stated that, now she assists the resident to brush his teeth after breakfast but that she does not assist him to brush his teeth after lunch as was his usual practice when he was more independent.

The CNA was further interviewed at 11:40AM on 7/14/11 regarding the assistance provided to the resident to shave. The CNA stated that the resident used to shave on his own. The CNA stated that, now, she hands the resident's electric shaver to him to see how much he can do himself and, as soon as she hands the shaver to him, he will say that he cannot do it himself. The CNA stated that she ends up shaving him when he looks scruffy. She stated that she usually gets the resident up in the morning and goes over his face with the shaver. She stated that she usually shaves the resident every other day but that the resident was not shaved on this day or the day before either. The CNA stated that she had noticed that the resident did look a little scruffy today.

The evening shift CNA was interviewed at 3:05PM on 7/14/11 and stated that the resident needs assistance to brush his teeth now. She stated that the aides set up his supplies and give him a basin to rinse his mouth. The CNA stated that she assists the resident to brush his teeth before going to bed but that she does not assist the resident to shave.

During the same interview with the LPN noted above, the LPN stated that, now that the resident requires assistance to shave and brush his teeth, his preferences should still be honored and that the CNAs should make sure that he is shaved daily and that his teeth are brushed after his meals.

415.12(a)(3)

Based on observation, interview and record review, a Care Plan was not in place to address a resident's personal wishes related to shaving and brushing his teeth. This was evident for one of twenty-five sampled residents and resulted in the potential for more than minimal harm that is not immediate jeopardy (Resident #16).

The findings are:

Resident #16 has diagnoses including Parkinson's Disease, Schizophrenia, heart and respiratory diseases. The resident has resided at the facility on a long term basis. He was hospitalized and readmitted to the facility on 4/27/11.

The resident was observed from 4/27/11 - 5/3/11 following his readmission and a comprehensive MDS (Minimum Data Set) assessment for a significant change in the resident's status was done. According to the MDS, the resident was usually understood when communicating and required the extensive assistance of one person with his personal hygiene, including brushing his teeth and shaving.

The resident was observed numerous times over a four day period including at 12:10PM on 7/11/11, 9:00AM on 7/12/11, 3:00PM on 7/13/11 and 11:30AM on 7/14/11. He was not clean shaven and was noted to have visible food debris between and on the surfaces of his teeth at those times.

The Licensed Practical Nurse (LPN) who works the day and the night shift was interviewed at 12:40PM on 7/14/11. The LPN stated that the resident is accustomed to do things a certain way and that he needs to have things done in that certain way to be comfortable. The LPN stated that the resident used to be independent in performing his personal hygiene and that it was very important for him to be well groomed. The LPN stated that he always dressed meticulously and paid attention to keeping his hair combed, face shaved and teeth brushed. She stated that he always brushed his teeth himself after every meal.

The resident's current 7/11 Care Plans and CNA (Certified Nurse Aide) Care Guide were reviewed for hygiene needs. Instructions for mouth care were not evident in the Care Plan. A profile sheet in the CNA Care Guide stated that the resident could have obsessive tendencies. According to the CNA Care Guide, the resident required extensive assistance with hygiene and the CNA Accountability Record for July, 2011 was initialed to indicate that mouth care was performed daily on the day and evening shifts.

The day shift CNA was interviewed at 9:25AM on 7/14/11 regarding the assistance provided to the resident to clean his teeth. The CNA stated that, when the resident was more independent, he brushed his teeth after every meal because that was his routine and it was very important for him. The CNA stated that, the resident can still brush his teeth and rinse his mouth himself if she takes him to the sink and sets up his supplies. The CNA further stated that, now she assists the resident to brush his teeth after breakfast but that she does not assist him to brush his teeth after lunch as was his usual practice when he was more independent.

Further review of the resident's Care Plans, Care Guide and Accountability Records noted above revealed that there were no instructions for shaving or documented evidence of shaving being done.

The CNA was further interviewed at 11:40AM on 7/14/11 regarding the assistance provided to the resident to shave. The CNA stated that the resident used to shave on his own. The CNA stated that, now, she hands the resident's electric shaver to him to see how much he can do himself and, as soon as she hands the shaver to him, he will say that he cannot do it himself. The CNA stated that she ends up shaving him when he looks scruffy. She stated that she usually gets the resident up in the morning and goes over his face with the shaver. She stated that she usually shaves the resident every other day but that the resident was not shaved on this day or the day before either. The CNA stated that she had noticed that the resident did look a little scruffy today.

The evening shift CNA was interviewed at 3:05PM on 7/14/11 and stated that the resident needs assistance to brush his teeth now. She stated that the aides set up his supplies and give him a basin to rinse his mouth. The CNA stated that she assists the resident to brush his teeth before going to bed but that she does not assist the resident to shave.

During the same interview with the LPN noted above, the LPN stated that, now that the resident requires assistance to shave and brush his teeth, his preferences should still be honored and that the CNAs should make sure that he is shaved daily and that his teeth are brushed after his meals.

415.11(c)(1)

The " old building " wing is a wood frame construction, fully protected by an automatic extinguishing system (sprinklers), but is more than one story; the wing has three stories. The first floor has the following resident use areas: living rooms, library, and dining room (no resident sleeping rooms). The facility's main kitchen is also on the first floor. The second floor has offices; the third floor has apartments for staff.

200 NFPA 101: 19.1.6.2
10NYCRR 711.2(a)(1)