Failure to Provide Routine Bathing Assistance for Resident Requiring ADL Support
Penalty
Summary
A deficiency occurred when a resident with multiple sclerosis, post-surgical status, and other medical conditions did not receive routine bathing assistance as required. The resident was cognitively intact and required assistance with activities of daily living (ADLs), including bathing, dressing, and grooming, as documented in the Minimum Data Set (MDS) and care plan. The care plan specified that the resident should be bathed according to her preferences and receive assistance with transfers and self-care, but lacked specific instructions regarding management of surgical sites or any restrictions on showering. Despite being on enhanced barrier precautions, there were no documented orders restricting bathing or showering due to surgical incisions. The resident and her family reported that she had not received a bath or shower since admission, and that she wished to have her hair washed before medical appointments, but this was not accommodated. Staff offered a sponge bath, which the resident declined in favor of a shower, but she was told she would have to wait for the next scheduled shower day. The resident stated that neither physical nor occupational therapy had worked with her on shower transfers, and staff documentation showed repeated entries of 'not applicable' for bathing assistance over several weeks. The first documented shower and hair wash occurred approximately three weeks after admission. Interviews with staff, including the physical therapy assistant, clinical coordinator, and director of nursing, revealed that bathing was scheduled weekly based on room assignment, with limited flexibility for resident preferences. Staff were unaware of any medical restrictions on showering, and no provider orders restricting bathing were found in the resident's records. Facility policy required person-centered care and support for resident preferences in ADLs, but documentation and interviews confirmed that the resident did not receive the necessary assistance with bathing for an extended period.