Failure to Provide Scheduled Showers and Timely ADL Assistance
Penalty
Summary
The facility failed to ensure that dependent residents received scheduled showers and timely assistance with activities of daily living (ADLs), as evidenced by medical record reviews, resident and staff interviews, and policy review. Three residents were affected, each with varying degrees of cognitive and physical impairment, and all were dependent on staff for bathing and other ADLs. Documentation showed significant gaps between scheduled showers and actual bathing events, with some residents going up to 11 days without a shower or bed bath, and no evidence that care was offered or refused during these periods. For one resident with chronic respiratory and cardiac conditions, staff were documented as refusing to provide care due to frustration with the resident's behavior, resulting in the resident waiting extended periods for assistance and sometimes not being offered showers as scheduled. Interviews with CNAs, a unit manager, and the DON confirmed that staff frequently refused to care for this resident, and that the issue was ongoing and known to management. The resident also reported delays in receiving nighttime care, with staff claiming uncertainty about who was assigned to assist her. Another resident with severe cognitive impairment and a third resident requiring moderate staff assistance for bathing also experienced missed or delayed showers, with documentation showing long intervals without care and no record of refusals. The DON confirmed that these residents were not offered or provided showers as required. Facility policy required staff to provide care and services for all ADLs, including bathing, but this was not consistently followed for the residents reviewed.