Failure to Provide Scheduled Showers and ADL Assistance for Resident with Dialysis Port
Penalty
Summary
A deficiency was identified when a resident with a history of transient cerebral ischemic attack, sepsis, acute kidney failure, dependence on renal dialysis, unsteadiness, muscle weakness, and cognitive communication deficit did not receive scheduled showers or adequate assistance with activities of daily living (ADLs). The resident was cognitively intact and required extensive assistance with bed mobility, transfers, and toilet use. The care plan indicated total dependence on staff for bathing and noted a behavior problem related to refusal of showers, but did not address how to meet bathing needs when showers were refused or not possible. Observations and interviews revealed that the resident was often dressed in a hospital gown with greasy hair and reported receiving only bed baths, which were infrequent. The resident stated she would like to receive showers but was told she could not due to her dialysis port. Documentation showed only four baths provided in the previous 30 days, and the resident reported the last bed bath was approximately two months prior. Staff interviews confirmed that bed baths were provided instead of showers, citing the dialysis port as the reason, and that the port was not always covered by CNAs, as it was considered outside their scope of practice. Further interviews with clinical staff, including a nurse practitioner and a regional compliance nurse, indicated that the dialysis port could be covered to allow showers and that there was no medical directive prohibiting showers for residents with dialysis ports. The facility's policies required care plans to document necessary precautions for residents with renal conditions and to respect resident rights regarding bathing preferences. However, the care plan and documentation did not adequately address the resident's needs or refusals, leading to missed opportunities for personal hygiene care.