Failure to Provide Scheduled ADL Assistance for Bathing and Showering
Penalty
Summary
Facility staff failed to provide scheduled assistance with activities of daily living (ADLs), specifically bathing and showering, for two residents who were dependent on staff for personal care. Both residents had complex medical conditions, including epilepsy, multiple sclerosis, hemiplegia, dementia, and other diagnoses that required substantial or maximal assistance for ADLs such as bathing, grooming, dressing, and toileting. Care plans for both residents specified the need for regular showers multiple times per week, but documentation and interviews revealed that these scheduled showers were frequently missed. Review of shower tracking logs showed significant gaps in care, with one resident receiving only 2 to 5 showers out of 12 or 13 scheduled opportunities per month, and the other receiving 2 to 4 showers in similar periods. Both residents reported not receiving showers as scheduled, with one expressing feelings of depression and the other describing discomfort and frustration due to prolonged periods in soiled briefs. Family members and a nurse practitioner also reported concerns, including poor hygiene, skin issues, and evidence of neglect, such as a strong odor, dirty clothing, and untrimmed fingernails. The nurse practitioner reported the situation to the state health department after observing these conditions during a clinic visit. Interviews with CNAs confirmed that showers were regularly missed, often due to low staffing. The administrator was unable to provide additional shower records and was unfamiliar with the documentation process, while the DON confirmed that no other records were available and that CNAs were expected to chart showers in the tracking software. A newly hired LPN stated she had not received instructions on cosigning shower logs. The ombudsman also noted that missed showers were a common concern among residents during a routine visit.