Failure to Provide Scheduled Showers and Document Care for Dependent Resident
Penalty
Summary
A deficiency occurred when a resident who was dependent on staff for all activities of daily living, including bathing, did not receive scheduled showers as required. The resident was observed with oily hair and food debris on clothing, and documentation showed that only one shower was provided since admission, despite being scheduled for showers twice weekly. Staff interviews revealed that bed baths were given instead of showers due to lack of assistance and time constraints, and that showers were often not documented or completed as scheduled. The resident had severe cognitive impairment, was diagnosed with multiple medical conditions including Alzheimer's, chronic kidney disease, and muscle weakness, and required total staff assistance for personal hygiene. The care plan specified that staff should provide a sponge bath when a full bath or shower could not be tolerated, but there was no consistent documentation of refusals or communication with the resident's power of attorney regarding missed showers. The nurse and CNA were responsible for documenting showers and refusals, but records were incomplete for several scheduled shower dates. Interviews with staff, including the CNA, nurse, MDS nurse, and DON, confirmed that the process for documenting and following up on shower refusals was not consistently followed. The facility did not have a specific policy for activities of daily living or showers, and the job descriptions for CNAs and nurses indicated responsibility for assisting with bathing and supervising care. The lack of documentation and follow-up led to the resident not receiving the scheduled showers and appropriate hygiene care.