Failure to Provide and Document Scheduled Showers for Dependent Residents
Penalty
Summary
The facility failed to provide showers as scheduled for two residents who were dependent on staff for activities of daily living, specifically bathing. For one resident with spina bifida, paraplegia, and a urostomy, care plans and physician orders required substantial staff assistance for scheduled showers and documentation of refusals. However, documentation revealed missed showers, lack of proper recording of refusals, and incomplete follow-through on required documentation in both the electronic medical record and on shower sheets. Interviews with staff confirmed that the resident was not consistently offered showers as scheduled, and that refusals were not always documented or reported according to facility policy. For another resident with peripheral vascular disease and multiple wounds, care plans and orders also required total staff assistance for bathing and documentation of refusals. Review of records showed inconsistent documentation of showers and refusals, with several instances where shower sheets were not signed by a nurse and no corresponding nursing progress notes explaining the refusals. Staff interviews indicated that the process for documenting refusals and ensuring nurse follow-up was not consistently followed, and that some showers or bed baths may not have been offered or properly recorded. Facility policy required that all showers or refusals be documented, including the reason for refusal, interventions taken, and nurse sign-off. The lack of consistent documentation and failure to follow established procedures for offering and recording showers and refusals resulted in these two residents not receiving scheduled showers or appropriate documentation, placing them at risk for skin breakdown and diminished quality of life.