Based on observation, interview, and record review, the facility failed to have a proactive beneficial system in place for the prevention of falls for all residents, to include specifically those at heightened risk of falls, due to their past history of recurring falls, and: - failed to identify the direct root causes of falls for the implementation of individualized interventions; - failed to assess fall events and details comprehensively and ensure fall documentation was in place and consistent across disciplines; - failed to ensure staff had the necessary tools and knowledge to provide fall prevention interventions on an ongoing daily basis; - failed to ensure resident care plans were updated with interventions related to fall safety and address the resident's current medical, physical, or cognitive limitations, for 8 (#S 4, 6, 7, 8, 9, 17, 19, and 22) of 8 sampled residents. These falls included falls with major injury with fractures for 3 (#s 4, 7, and 22), and a hospitalization for 1 (#22) of 8 sampled residents, leading to the deterioration of the resident's condition, and the resident passed away within a month of the last fall with major injury. Findings include: IMMEDIATE JEOPARDY On 3/1/23 at 2:10 p.m., the facility's Director of Nursing and MDS Coordinator, in the absence of the facility administrator, was notified an Immediate Jeopardy existed in the area of 689 - Prevention of accidents and hazards. The Severity and Scope identified for the Immediate Jeopardy was identified to be at the level of a K, and upon removal of the immediacy, was lowered to an H. 1. Review of resident #22's Significant Change MDS, with an ARD of 5/7/22, showed under Section G, Functional Status, the resident was marked as, 0 = Independent - no staff help or oversight at any time for the following ADLs: - Bed mobility - Transfer - Walk in room - Walk in corridor - Dressing Resident #22 was marked as 1 = Supervision - oversight, encouragement, or cueing for the following eating, toilet use, and personal hygiene. Review of resident #22's diagnoses, from the 5/7/23 Significant Change MDS, included Dementia, a history of left hip fracture, and Glaucoma. Review of resident #22's Brief Interview for Mental Status exam, dated 5/7/22, showed she scored a 0, reflecting severe cognitive impairment. a. Review of resident #22's nursing progress notes, dated 6/21/22, showed: - An unwitnessed fall occurred outside of the dining room. - Resident #22 was observed by staff, 1/2 laying and ½ sitting on her left side about a foot away from dining room doorway. - Resident #22's walker was noted to be parked just inside the dining room door. It was concluded she was walking without it (the walker), again. - Resident #22 denied pain. Vital signs taken after the fall showed a blood pressure of 73/41 (low blood pressure). She was identified as, drowsy, but responds well to (the) penlight. Review of resident #22's hard copy paper care plan for falls, with a print date of 7/1/22, did not show fall prevention interventions related to her walking without a walker, vision impairments, or the potential impact these had on falls. An intervention related to resident #22's blood pressure showed: - Remind me when I am changing positions that I do so slowly so my blood pressure adjusts slowly with the change, and the intervention had not been revised since 3/18/19, and failed to address the resident's advancement in dementia, and if the intervention was evaluated as being successful, due to her severe cognitive deficit and recall ability. B. Review of resident #22's nursing progress notes, dated 7/25/22, showed: - An unwitnessed fall occurred when she was walking near her door without her walker. - Resident #22 was observed laying on the floor. - RN and OT assessed resident, .asking where it hurt, all resident said was 'owe, owe, owe.' When I touched her right hip she complained of an increase in pain. - Resident was sent to the hospital where a UTI and closed right femur fracture were diagnosed. After the fall on 7/25/22, and the subsequent hospital admission for the hip fracture, resident #22 was admitted back to the facility for comfort care and services. Review of resident #22's Significant Change MDS, with an ARD of 8/4/22, showed under Section G - Functional Status, the resident was marked as, 4 = Total Dependence - full staff performance every time during the entire 7-day look back period, for the following ADLs: - Bed mobility - Eating - Tilting - Personal hygiene Resident #22 was marked as 8 = for the ADL activity itself did not occur during entire period for the resident walking in the room and corridor. Review of the investigation file for resident #22's fall on 7/25/22, was requested during the entrance conference on 2/28/23. It was found no new interventions were added to her care plan related to the fall. During an interview on 3/1/23 at 2:17 p.m., staff member A and B stated resident #22 had been completely ambulatory before the fall, in which she sustained the fracture, on 7/25/22. Resident #22 passed away on 8/21/22. She had a change and decline in condition after her fall with significant injury, and passed away approximately one month after the fall. 2. Review of resident #7's nursing progress notes, dated 9/22/22 - 12/10/22, showed the resident had five falls, two with minor injury, and one fall with major injury. a. Review of resident #7's nursing progress notes, dated 9/2/22, showed: - Resident had an unwitnessed fall in the bathroom. - Staff was alerted to the resident by her roommate turning on the call light and yelling for help. - Resident #7 was found, . head between the toilet and the wall .laying face down more on the left shoulder .both legs were facing the doorway. - Resident #7 stated she had gotten herself out of bed, and used her walker to go to the bathroom, but slipped and fell. - Bruising was noted on the left side of the resident's head. Review of resident #7's fall care plan, printed on 2/28/23, showed [Resident #7] was reminded to call for help, for the 9/2/22 fall. The care plan failed to address ensuring the resident's call light was within reach, environmental factors were addressed, or that she was walking to the bathroom in the dark and if it was a concern or risk related to the fall. b. Review of resident #7's nursing progress notes, dated 10/30/22, showed, Resident has experienced moderate - severe confusion over past 48 hours. Visual hallucinations of seeing people and things that are not present. These hallucinations continued to be documented through review of the resident's electronic medical record. Review of resident #7's nursing progress notes, dated 10/30/22, showed: - Resident #7 had an unwitnessed fall in the doorway between her room and hallway. - She was found with her feet on the transitional strip on the floor, and her head facing her recliner. She hit her shoulder and elbow during the fall. - Resident #7 stated her walker had caught the transitional strip as she was turning around. - Resident #7 was diagnosed with a right shoulder fracture. Review of resident #7's fall care plan, printed on 2/28/23, showed the intervention for the fall on 10/30/22 included, Remind me to walk out so that I am clear from the doorway before turning around, and Ghost alarm . because of increased confusion and hallucinations. The care plan failed to address the residents ADLs or transfer status, maneuvering the walker safely, the contributing factor of catching on the transitional strip, or updated for increased risk of falling once her arm had been fractured and placed in a sling. c. Review of resident #7's nursing progress notes, dated 11/21/22, showed: - Resident #7 fell while walking out of the bathroom with a CNA. - The resident was lowered to the ground, by the CNA, with the gait belt. Review of resident #7's fall care plan, printed on 2/28/23, showed the intervention added after the 11/21/22 fall was, ONLY USE WHEELCHAIR TO TAKE [RESIDENT #7] TO TOILET FROM NOW ON. Review of resident #7's nursing progress notes, dated 12/4/22, showed: - Resident #7 fell while being assisted from the bathroom by a CNA. - The resident was lowered to the ground as she started to fall. - Resident #7 received a skin tear from the walker to her left forearm. Review of resident #7's care plan failed to show when the previous intervention of only taking the resident to the bathroom with a wheelchair had been discontinued, or if the facility modified the level of staff assistance needed for ADL care when using a walker and one arm in a sling. d. Review of resident #7's nursing progress notes, dated 12/10/22, showed: - Resident #7 fell in her room and was found sitting on the floor next to her bed. - Resident #7 stated she was moving from the recliner to her bed. As I started to sit on the edge of the bed I saw my sister on or near the other side of the bed. Review of resident #7's fall care plan, printed on 2/28/23, showed the intervention added after the 12/10/22 fall included, Reminded [Resident #7] she has to use call bell and have staff assist her to transfer. The care plan failed to address the effectiveness and whether reminding the resident would be beneficial since the resident had cognitive deficits and was hallucinating. 3. During an observation of resident #6's room, on 3/1/23 at 8:42 a.m., there was a large wardrobe next to the doorway entrance. The bottom drawers were at floor level, which would require someone to bend far over to reach and open the drawers. Resident #6 was sitting in his recliner, with a bedside table next to him, and his walker on the other side of the table. Review of resident #6's diagnoses, as of 3/1/23, showed: - Unspecified macular degeneration, - BPH, - Unspecified mononeuropathy or right and left lower limbs, - Muscle weakness, - Benign Paraxysmal Vertigo . Review of resident #6's Morse Fall Scale, dated 2/17/23, showed the resident, overestimates or forgets limits. Review of resident #6's fall worksheets, dated 9/19/22 - 1/6/23, showed the resident had ten falls in a four-month period. a. Review of resident #6's fall worksheet, dated 9/19/22, showed: - Resident #6 had an unwitnessed fall in his room during shift change. - He was found by the housekeeper, in a half-seated position, with his right knee bent under him. - The Resident stated he was getting clothes out of his closet, and tripped over the door stop, near the bathroom door. - His walker was noted to be beside his bed. - Eyesight and hearing were both marked as impaired for the resident. - Resident #6 experienced a sore right knee and pain during ambulation which required the temporary use of a wheelchair. Review of resident #6's care plan, initiated 9/5/18, showed the updated intervention after the fall was, [Resident #6] was reminded he needs to be using the walker everywhere in his room. The door stop was not addressed. b. Review of resident #6's fall worksheet, dated 9/30/22, showed: - Resident #6 had an unwitnessed fall in his room. - He was found sitting next to his closet with his back to the bathroom door. - The resident stated he was trying to pick up a hanger he had dropped on the floor. - His walker was noted to be under his TV, about 6ft away. - Resident #6 had a bruise to his left elbow. Review of resident #6's care plan, initiated 9/5/18, showed the updated intervention after the fall was, [Resident name] was reminded that he is supposed to call for staff to pick things up from the floor because he gets off balance. The facility did not identify the trend in falls occurring with resident #6 getting objects from his closet. c. Review of resident #6's fall worksheet, dated 10/23/22, showed: - Resident #6 had an unwitnessed fall in the dining room. - He stated he was holding onto the dining chair while moving his walker away. - Resident #6 had a skin tear to his right elbow from the fall. Review of resident #6's care plan, initiated 9/5/18, showed the updated intervention post fall: - [Resident #6] was educated that he should keep the walker next to the table but he refuses. d. Review of resident #6's fall worksheet, dated 10/31/22, showed: - Resident had an unwitnessed fall in his room. - He was found lying on the floor on his right side. - Resident #6 stated he was trying to go from the bathroom to his chair, and the walker got caught on the transitional strip on the floor. The incident report for resident #6 showed predisposing environmental factors marked as, none. There was a failure to identify this was the second fall in under two months the resident had tripped over environmental pieces in his room. e. Review of resident #6's fall worksheet, dated 11/6/22, showed resident #6 had a witnessed fall in the dining room, and he stated he was just walking and lost his balance, tipping over the walker as he fell. Review of resident #6's nursing progress notes, dated 11/8/22, showed the IDT had discussed a wheelchair, but decided against it as the resident, does not follow direction on safety and positioning. f. Review of resident #6's fall worksheet, dated 11/22/22, showed: - Resident #6 had an unwitnessed fall in his bathroom. - He stated he had been trying to pull up his clothes and lost his balance. - Eyesight and hearing were marked as impaired. - Resident #6 had a reddened area to the back of his head. Review of resident #6's care plan, initiated 9/5/18, showed the updated intervention post fall was: - Reminded him to call for help if dizzy. There was a failure to identify eyesight had been marked as impaired on multiple fall worksheets and the potential impact it was having on repeated falls, and the facility did not address the dressing or loss of balance. g. Review of resident #6's fall worksheet, dated 11/25/22, showed resident #6 had an unwitnessed fall in his room. He stated he, .was moving my pillows on my bed, and I was gonna lean back against my walker, but it's not that sturdy. He reported he fell and then, had to skootch on my butt to call light. The incident report for resident #6 showed predisposing factors of furniture, crowding, and improper footwear. Review of resident #6's care plan, initiated date 9/5/18, showed the updated intervention post fall: - Reminded not to sit on his walker. The facility did not address the safety with the walker, crowding in the room, improper footwear, or furniture, but instead provided another reminder for the resident who who had cognitive deficits, and the care plan interventions did not address or identify the residents positioning when on the bed or pillow placement for future prevention. h. Review of resident #6's fall worksheet, dated 12/6/22, showed: - Resident #6 had an unwitnessed fall in his room. - He was found with his back against the bathroom wall, his right leg bent at the knee. - Resident #6 stated he was going back to his recliner and his foot slipped. - Resident #6 had a second fall 90 minutes later and stated his knee gave out. Review of resident #6's care plan, initiated date 9/5/18, showed the updated intervention post fall: - Reminded him that he needs to stay closer to the walker. The care plan was not updated to address the knee giving out, safety when using the bathroom, or increased monitoring or observations, but again the facility directed staff to remind him to stay closer to the walker when it was shown he did not have the ability to recall all staff directions or recommendations for safety. i. Review of resident #6's fall worksheet, dated 1/2/23, showed: - Resident had an unwitnessed fall in his room. - He stated he was getting socks out of his drawer and lost his balance. - Resident #6 had a contusion to his left forehead and skin tear to his right forearm. He also complained of right hip soreness. Review of resident #6's care plan, initiated date 9/5/18, showed the updated intervention post fall: - Reminded him that he can call for staff to get anything for him that he has to bend down for. The care plan interventions or modifications after this fall did not address the loss of balance, retrieving items from the drawer, or staff assisting with dressing for fall safety and prevention. j. Review of resident #6's fall worksheet, dated 1/6/23, showed: - Resident had an unwitnessed fall in his room. - Resident #6 stated he was sitting on a stool and trying to look in his drawers to find his checkbook when the stool tipped over. - Injuries included a skin tear to his right wrist described as, skin torn completely off. Review of resident #6's care plan, initiated date 9/5/18, showed the updated intervention post fall: - [Resident #6] was told not to be reaching down for things if sits on the stool. The plan did not address the resident's loss of balance off the stool, the use of the stool in general, or items being kept in areas where the resident would have to bend over in some capacity, which increased the risk of the resident falling. Review of resident #6's nursing progress note, dated 1/12/23, showed, [Resident #6's daughter] mentioned possibly having clothes left out for him, as that seems to be when he is at higher risk for falls. There is also mention of him limiting his fluids to avoid incontinence and this possibly contributing to dehydration (and dizziness). None of these identified concerns voiced by the the family member's comments were identified by IDT as fall risks. Over the course of these ten falls, resident #6 sustained five injuries to the right side of his body including: skin tears, bruises, knee, and hip pain. He had two falls with head injury. There was a failure to identify the trend in the resident's right sided injuries, or the resident being found on his right side, as reoccurring. All the interventions, identified by the IDT, were reminders. No new interventions were initiated based on the resident's predisposing factors, the environment, the resident's cognition or physical disabilities or limitations, or his medical status. There was not root cause analysis of the actual fall details for any of the falls, or a means to prevent future falls from occurring using a proactive approach. The facility did not increase monitoring or observations of the resident, have the staff increase ADL assistance, or consider optional placement of furniture or belongings. During an interview on 3/1/23 at 10:32 a.m., staff members A and B stated reminding residents to call for help had become a go to intervention. They stated they were at a loss for interventions with the non - complaint residents (specifically resident #6). During an interview on 3/1/23 at 1:00 p.m., staff member C stated there was a report sheet with important information about each resident for staff who were new. Review of this sheet did not list any interventions for fall prevention for resident #6. 4. During an observation on 2/28/23 at 8:01 a.m., resident #19 was asleep in her room. A tabs alarm was noted in her wheelchair nearby, and a motion alarm (ghost alarm) was on the floor next to her bed. Review of resident #19's Annual MDS, with an ARD of 9/6/22, showed the resident scored a four on the BIMS; reflecting severe cognitive impairment. a. Review of resident #19's nursing progress notes, dated 4/25/22, showed: - Resident #19 had an unwitnessed fall in her room. Her alarm sounded. - She was found on her left side with her wheelchair to the right and walker between her wheelchair and her bed. - Resident #19 stated she was trying to get up but didn't know where she was going. b. Review of resident #19's nursing progress notes, dated 9/15/22, showed: - Resident had an unwitnessed fall in her room. Her alarm sounded. - She was found laying on her left side behind her wheelchair in the bathroom doorway. - Resident #19 had bruising on her right cheek, a laceration under her right chin, skin tear to her right hand with bruising. c. Review of resident #19's nursing progress notes, dated 11/6/22, showed: - Resident #19 had an unwitnessed fall in her room. - She was found seated on the floor with her walker out of reach. Resident #19's fall worksheet showed poor lighting as a predisposing factor. Review of resident #19's fall care plan, printed on 2/28/23, the following interventions: - 4/25/22: Resident brought to common area for observations, alarms re-attached and on. - 9/15/22: Was reminded she needs to call for help .continue with the ghost alarm. - 11/6/22: Staff will check alarm after family leaves. No new interventions were initiated for #19's falls, based on predisposing factors, the environment, medical equipment, resident's health status or physical limitations, and a root cause analysis of the actual fall to identify direct root causes, was not completed for future fall prevention. Reminders were given to the resident who had cognitive deficits, and alarms continued to be used, which were a reactive alert for staff, rather than a proactive approach of anticipating the resident's needs to prevent a fall before it occurred. 8. During an observation and interview on 3/1/23 at 8:39 a.m., resident #8 was lying in her recliner, and a front wheel walker was placed to the right of her chair. She stated when she had the multiple falls last year (2022), they just happened. Resident #8 stated they (staff) tried to remind her each time she fell, of ways to prevent falling again,but she lost balance easily and continued to fall. She stated each time she fell there was not a specific reason for falling, it would just happen. Resident #8 stated she had multiple falls at home before coming to the facility. Resident #8 stated she had neuropathy and at times did not feel her feet when she was walking. During an observation on 3/2/23 at 9:58 a.m., resident #8 was lying on her bed. Resident #8's walker was positioned next to her recliner, approximately three feet away from her bed, out of her reach. Review of resident #8's diagnoses, as of 3/1/23, showed: - Pneumonia, unspecified organism, - Bilateral Primary Osteoarthritis of knee, - Repeated Falls, - Other Cerebral Infarction due to occlusion or stenosis of small artery, and - Polyneuropathy. - The diagnosis of Pneumonia was the only contributing factor identified in any of the four falls resident #8 sustained. Review of resident #8's Annual MDS, with an ARD of 12/23/22, showed under Section C, a BIMS score of 10, moderately impaired cognition. a. Review of resident #8's fall worksheet, dated 9/27/22 at 1:40 a.m., showed: - An unwitnessed fall occurred in resident #8's room, - Resident observed by staff lying on the floor, on her right hip, with a walker on each side of her, - Resident stated she was awoken by her spouse asking for a glass of water, - Resident stated she got up to get the water, tried to put her walker aside, and grabbed her spouse's walker to move it out of the way, - Resident stated she got tangled up in the two walkers and fell, and - An injury was observed of a small cut and hematoma to her left ring finger. The fall worksheet for resident #8 showed predisposing environmental factors of crowding of the furniture and poor lighting. Resident #8 had an increase in her melatonin from 1 mg to 3 mg on 9/26/22. The intervention to prevent future falls showed staff asked resident #8 to allow them to take care of her spouse and to stay in bed unless she needed to go to the bathroom. No root cause analysis was completed by the care team to address how/why resident #8 became tangled up in the walker. Review of resident #8's Morse Fall Scale, dated 9/30/22 at 2:20 p.m., showed a risk score of 90. A risk score above 45 was considered high risk. b. Review of resident #8's fall worksheet, dated 10/3/22 at 5:22 p.m., showed: - A witnessed fall occurred in resident #8's room, - Staff observed the resident talking on her phone, attempted to sit on recliner, but slid to the floor, - Resident was confused and had received a diagnosis of Pneumonia, and - No injuries were observed. The fall worksheet for resident #8 showed predisposing physiological factors of confusion, incontinence, recent changes in medications, recent change in cognition, recent illness, and weakness/fainted. There were no interventions listed on the fall worksheet to prevent future falls and no root cause analysis was completed by the care team to address why the resident slid to the floor from the chair. c. Review of resident #8's fall worksheet, dated 10/11/22 at 4:00 p.m., showed: - An unwitnessed fall occurred in resident #8's room, - Resident observed by staff sitting on her bottom, on the floor, with her walker next to her, - Resident stated she was transferring to her bed, the wheel of her walker became tangled in the wheel of the bedside table, which caused her to fall, and - No injuries were observed. The fall worksheet for resident #8 showed no predisposing environmental or physiological factors. The predisposing situation factor listed was the resident had used her walker. The immediate interventions taken showed, VS taken, assessment done, resident assisted to bed by CNA. No other interventions needed. No interventions were listed on the fall worksheet to prevent future falls and no root cause analysis was completed by the care team to show how contributing factors or causes were identified to prevent future falls. d. Review of resident #8's fall worksheet, dated 10/31/22 at 3:10 p.m., showed: - An unwitnessed fall occurred in resident #8's room, - Staff observed the resident's walker tipped over, the resident was sitting on the floor, and holding the back of her head, - Resident stated she was on the phone with family and became upset, she used her walker to go close the room door, - Resident stated she started to walk backwards and lost her balance, hitting her head on the trash container, and - Injury to back of the head was documented. The fall worksheet for resident #8 showed no predisposing factors were documented. The immediate interventions taken showed, Assess scene, person, took vitals set her in chair. No interventions were listed on the fall worksheet to prevent future falls and no root cause analysis was completed by the care team in an attempt to identify causes or other contributing factors. During an interview on 3/1/23 at 10:32 a.m., staff member A stated the process after a resident fell was to perform a nursing assessment, notify the family and provider, and start the electronic health record charting process. She stated the staff member who discovered a fallen resident was to fill out the fall worksheets. Staff member A stated the nurse on duty documented in the resident's progress note and risk management program. She stated fall worksheets were turned into staff members A and B, interventions were entered into the care plan, and falls were then reviewed on the first Tuesday and last Tuesday of the month. During an interview on 3/1/23 at 10:38 a.m., staff member B stated the facility needed to revamp their process concerning root cause analysis. She stated they (staff) knew the residents well because the facility was so small. Staff member B stated root cause processes needed improvement, including a completed, formal root cause analysis, and the development of additional interventions to add to the resident's care plans, to prevent future falls. During an interview on 3/1/23 at 10:47 a.m., staff members A and B stated they met with other disciplines and discussed a fall incident but had not performed a formal root cause analysis for the resident falls. During an interview on 3/1/23 at 10:54 a.m., staff members A and B stated they did not keep a fall log or have a process in place to track and trend resident falls. Review of the facility's policy titled, Falls and Fall Risk, Managing, last revised March 2018, showed: - Policy Statement - Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling. 5. During an observation on 3/1/23 at 3:23 p.m. resident #4 wheeled herself into the dining room. No staff were in the dining room at that time. Resident #4 had a coffee cup in her hand and a string clipped to the back of her shirt. She wheeled herself over the the sink, stood up from her wheel chair, the string was attached to a chair alarm, and the string was pulled tight, but did not come loose from the alarm. The alarm did not sound. Resident #4 dumped her cup in the sink, rinsed the cup out, and sat back down in her wheel chair. The chair alarm sounded. Resident #4 reached around behind her, grabbed the alarm while saying she hated it. Resident #4 then pulled the alarm around to in front of her, shut the alarm off, and then tossed it back over her left shoulder. Resident #4 said how annoying the alarm was. No staff members came to check on resident #4 while her alarm was sounding off. The alarm was active for about 20 seconds. Review of resident #4's electronic medical record showed diagnoses including: - pathological fracture of the left femur, - displaced intertrochanteric fracture of the right femur, - right humerus fracture, - fractures of the right pubis, - impaired mobility, - chronic pain, and - arthritis. Review of resident #4's Annual MDS, with an ARD of 12/16/22, showed: - Resident #4 was moderately cognitively impaired. - Resident #4 needed the assistance of one staff member for transfers, walking in her room, walking in the hallway, with getting dressed, using the toilet, her personal hygiene, and her bathing. - Resident #4 had a range of motion impairment to the upper and lower sections of both sides of her body. - Resident #4 was not steady when moving from a seated to standing position, when walking, and when moving on and off the toilet. She was only able to stabilize herself with human assistance. - Resident #4 used a walker and or a wheelchair for mobility. - Resident #4 had a fall with a major injury. a. Review of resident #4's fall worksheet, dated 10/2/22 at 10:30 a.m., showed: - An unwitnessed fall occurred in the resident's room. - Resident #4 was found on the floor, on her left side. - Resident #4 said she was trying to get something out of her closet, saying she just fell. - No injuries or complaints of pain were documented on the fall worksheet. The fall worksheet showed the staff member completing it did not identify predisposing environmental or physiological factors. No interventions were put into place to prevent further falls, and a root cause analysis was not completed for the identification of the direct cause of the fall, and the facility did not address concerns related to the resident's dressing abilities, obtaining clothing from closet safely, or the current level of ADL assistance and if the resident needed more help. Review of r[TRUNCATED]