Failure to Honor Resident's Choice for Shower
Penalty
Summary
A deficiency was identified when a resident with vascular dementia, anxiety, depression, and insomnia was not provided with the opportunity to receive a shower as per her care plan and posted shower schedule. The resident was assessed as moderately cognitively impaired, requiring substantial to maximal assistance with personal hygiene, and was frequently incontinent. Her care plan specified that activities of daily living, including personal care, would be completed with staff support to maintain her highest practical functioning. The posted shower schedule indicated she was to be offered a shower on Wednesdays and Sundays during the night shift. A review of the resident's activity of daily living (ADL) shower sheet and nursing progress notes for the first week after admission revealed no documentation that the resident had received a shower, nor was there evidence that she was offered a shower and refused. The only documented hygiene provided was a bed bath on two occasions, with no record of showers being offered or given. The resident's family member, who was present daily, confirmed that the resident had not received a shower since admission and had specifically requested one from staff, but was repeatedly told it would occur on scheduled days, which did not happen. Interviews with nurse aides and the Director of Nursing confirmed that showers were to be offered according to the posted schedule, and refusals were to be documented and reported to nursing staff. However, the nurse aides could not recall providing a shower or documenting any refusals, and the records supported that no showers were given or offered. The Director of Nursing stated the expectation that showers be offered and refusals documented, but this was not reflected in the resident's records or staff recollections.