Failure to Honor Resident's Bathing Preferences as Directed by Legal Decision Maker
Penalty
Summary
The facility failed to provide care in accordance with the expressed preferences of a resident's legal decision maker regarding bathing routines. The legal decision maker had clearly communicated, both verbally and in writing, that the resident was to receive full showers at least twice a week and that bed baths were not to be substituted for showers under any circumstances. Despite these instructions, documentation and interviews revealed that the resident received a bed bath instead of a scheduled shower, and there was no evidence that a shower was provided on the next scheduled day. The resident's care plan did not specify the requirement for full showers only, and the CNA documentation did not reflect that showers were consistently provided as requested. The resident in question had a history of End Stage Renal Disease and Parkinson's Disease, with severely impaired cognition, and was dependent on staff for all bathing activities. The resident was unable to clearly communicate her preferences regarding showers due to a language barrier and cognitive impairment. The legal decision maker had offered to assist with communication if the resident appeared to refuse showers, but staff did not consistently contact the family as requested. Records showed that the last documented shower occurred several days prior to the incident, and subsequent documentation indicated a refusal but did not show that the family was contacted or that further attempts were made to provide a shower as per the care plan. The facility's documentation practices and care planning failed to reflect the specific bathing preferences, leading to the resident not receiving care in accordance with the legal decision maker's wishes.