Failure to Honor Resident Bathing Preferences and Promote Self-Determination
Penalty
Summary
The facility failed to promote and facilitate resident self-determination by not providing timely bathing in the form preferred by several residents. Multiple residents with varying degrees of cognitive impairment and physical limitations reported not receiving showers as requested, with some only receiving bed baths or going extended periods without any form of bathing. Documentation and interviews revealed inconsistencies in offering showers, lack of clarity on whether showers or bed baths were provided, and gaps of several days between bathing opportunities. One resident with a history of stroke, hemiplegia, and depression expressed a preference for showers over bed baths, but records showed reliance on family-provided bed baths and infrequent staff-provided bathing. Another resident with a leg fracture and impaired mobility reported receiving only occasional sponge baths, despite a care plan indicating the need for bathing or showering twice weekly. A third resident, with altered mental status, kept a personal calendar and noted significant gaps between showers, sometimes waiting up to eleven days, and reported feeling unclean and having requests for showers unmet. Staff interviews indicated confusion regarding shower schedules, documentation practices, and the process for handling refusals or preferences. Some staff were unaware of the frequency with which residents should be offered showers, and there was no consistent system for ensuring residents' bathing preferences were honored. The Director of Nursing and other staff assumed that showers were being offered as scheduled, but documentation and resident reports did not support this, leading to unmet resident preferences and a failure to support resident choice in personal care.