Failure to Honor Resident Care Preferences and Shower Needs
Penalty
Summary
The facility failed to honor a resident's documented and verbal preferences regarding care assignments and shower routines. The resident, who is quadriplegic and entirely dependent on staff for activities of daily living, had previously experienced a traumatic incident with a specific CNA during a shower. Despite the resident's clear and repeated refusals to receive care from this CNA, the facility continued to assign her to his care on multiple occasions. The resident had communicated his preferences to the Quality Assurance Nurse (QAN) and provided a CNA preference list, but these preferences were not consistently documented or communicated among staff, leading to repeated assignments against his wishes. Additionally, the facility imposed a 15- to 30-minute shower time limit on the resident, despite his need for longer showers due to his extensive physical limitations and medical diagnoses. Staff interviews confirmed that the time restriction was implemented without the resident's agreement and that the resident's preferences for longer showers were not honored. The Director of Nursing (DON) acknowledged that a dependent resident would typically require at least 45 minutes for a proper shower and that the imposed time limit was not respectful of the resident's dignity or individual needs. Record reviews and staff interviews revealed that the facility's care plan and interdisciplinary team (IDT) notes included interventions to document and honor the resident's CNA preferences and to monitor his satisfaction with care. However, these interventions were not effectively implemented. The lack of a consistent schedule coordinator and inadequate communication among staff contributed to the failure to follow the resident's care plan, resulting in repeated assignments of the unwanted CNA and the enforcement of a shower time limit that did not accommodate the resident's needs.