Failure to Assess and Develop Interventions for Resident Refusing Personal Hygiene Care
Penalty
Summary
The facility failed to comprehensively assess and develop individualized interventions to promote acceptance of bathing and personal hygiene care for a resident with impaired memory and cognitive function. The resident was observed to be disheveled, with greasy hair, soiled and long fingernails, and a visible brown substance on his hands. Documentation showed a pattern of the resident refusing showers and personal hygiene care, with staff offering alternative methods such as basin and wipes, which were also refused. Despite these repeated refusals, there was no evidence in the medical record that the facility had assessed or evaluated alternative approaches to facilitate the resident’s acceptance of care. Interviews with staff revealed that some nursing assistants had more success with the resident by using specific approaches, such as offering care when the resident returned from smoking or having the shower water running and hot. However, these successful strategies were not documented in the care plan, and other staff did not consistently re-approach the resident to provide care. Staff also noted that nail care was not consistently offered or documented, and there was uncertainty about whether it was being performed or recorded appropriately. The resident’s care plan identified a need for assistance with personal hygiene and bathing due to mental illness and impaired cognition, and set a goal for the resident to be clean and well-groomed. However, the care plan lacked specific interventions or strategies to address the resident’s repeated refusals or to promote acceptance of care. The facility’s personal hygiene policy required assistance based on individual needs and preferences but did not address how to manage or evaluate repeated refusals of care.