Failure to Honor Resident's Shower Preferences
Penalty
Summary
A resident with moderate cognitive impairment expressed a preference to shower every day and to have showers in the morning, which was documented during an interview and in her admission assessment. The resident's preferences were also recorded in a customary routines and activities observation, indicating it was very important for her to choose the type of bath and that she preferred to be bathed more than twice per week in the morning. Despite this, the resident was scheduled for showers only twice weekly on the evening shift, contrary to her stated preferences. Shower reports showed that the resident was offered showers on various dates, with several refusals, but there was no documentation that her preferences were reassessed or that the timing of the showers matched her morning preference. Progress notes did not indicate that the resident was offered a shower daily or that her preferences were revisited after refusals. The care plan did note her preference for daily showers, but this was not reflected in the actual shower schedule or in follow-up actions. Interviews with facility staff, including the DNS, confirmed that the resident's preferences should have been communicated and implemented, but this did not occur. The facility's policy required that resident preferences be identified and shared with the interdisciplinary team, but there was no evidence this process was followed in this case.