Failure to Provide Timely Showers and Document Care for Dependent Residents
Penalty
Summary
The facility failed to ensure that residents who were dependent on staff for activities of daily living, specifically grooming and personal hygiene, received baths or showers in a timely manner. Two residents with significant medical conditions, including cerebral infarction, osteoarthritis, and paralysis, were identified as being dependent on staff for all ADLs except eating and were frequently incontinent of bowel and bladder. Both residents were scheduled to receive showers twice weekly, but documentation showed significant lapses, with one resident going up to 17 days and another up to 13 days without a shower. There was no documentation of showers being offered or completed on other days, nor was there documentation regarding missed showers or extended periods without bathing. The facility's policy required staff to document the date, time, and details of showers or baths, including refusals and interventions taken, and to notify supervisors and physicians as appropriate. However, the care plans for both residents did not address shower frequency preferences or patterns of refusal, and staff failed to document refusals or missed showers as required. Interviews with staff revealed inconsistent awareness and practices regarding shower refusals, documentation, and notification of nursing staff or families. Some staff were unaware of recent refusals, and others indicated that nurses were not informed about which residents received showers or refused them. Further interviews with nursing and administrative staff confirmed that there were designated shower aides, but coverage was limited, and sometimes residents did not receive even one shower per week. The Director of Nursing and Administrator both stated that residents should receive two showers per week unless refused, and refusals should be documented. However, neither was aware of residents going more than 10 days without a shower, and documentation did not support that refusals were consistently recorded. Family members also reported having to request showers and being asked to provide them themselves, indicating a lack of consistent care and communication.