Failure to Provide Consistent Bathing and ADL Assistance
Penalty
Summary
The facility failed to provide consistent bathing opportunities and assistance with activities of daily living (ADLs) for two residents who were dependent on staff for personal care. One resident, with diagnoses including anxiety, diabetes mellitus, muscle weakness, depression, and moderately impaired cognition, was documented as dependent on staff for bathing and toileting. Review of her electronic medical record over a 120-day period showed infrequent bathing, with only a few showers and sponge baths documented, and multiple days marked as 'Not Applicable' without evidence that she was unavailable for care. There was also a lack of documentation regarding refusals or alternative bathing offers. Observations found her call bell and bedside table out of reach, and her soft call light was missing. Another resident, with end-stage renal disease, diabetes, absence of a left leg, and mild cognitive impairment, was also dependent on staff for all ADLs, including bathing. Her care plan indicated a preference for twice-weekly baths, but records showed missed scheduled baths on several occasions without documentation of refusals or reasons for the missed care. The resident reported not receiving her preferred Sunday baths for several weeks and expressed dissatisfaction with her hygiene, noting greasy hair and dirty fingernails. Staff interviews confirmed that bathing was to be offered at least twice weekly, with refusals to be documented, but the records did not reflect this practice. The facility's ADL policy required that residents receive assistance with ADLs based on individualized care plans and that their abilities should not diminish unless unavoidable due to clinical condition. Despite this, both residents did not receive consistent bathing opportunities as required, and documentation was lacking regarding care provided, refusals, or alternative offers. These failures were identified through observation, record review, and staff and resident interviews.