Failure to Provide Required Showers and Hygiene Care Due to Staffing Shortages
Penalty
Summary
Facility staff failed to provide showers twice weekly to multiple residents who required assistance with activities of daily living, as evidenced by medical record reviews, observations, and interviews. Several residents with significant medical conditions, such as systemic lupus erythematosus, chronic pain, heart failure, hemiplegia, and cognitive deficits, were documented as needing substantial or total staff assistance for bathing and showering. Despite physician orders specifying shower days, records showed that these residents often received only bed baths or went extended periods without showers, with no documentation of refusals. Interviews with staff and residents revealed that the lack of showers was not due to resident refusals but rather staffing shortages and time constraints. Staff reported high resident-to-GNA ratios, sometimes as high as 27 residents per two GNAs, which limited their ability to provide showers and even basic hygiene care such as changing and turning residents. Residents and their representatives confirmed that showers were missed and that refusals were not the cause, with some residents stating they were only changed once per shift and not turned as frequently as required. Observations further supported these findings, with one resident noted to have a strong odor of feces and visibly dirty hair, and documentation confirming missed showers over multiple weeks. Facility leadership acknowledged the expectation for twice-weekly showers and the need to document refusals but admitted that this was not being done. The deficiency was identified for five residents during the complaint survey, with consistent evidence of missed showers, lack of documentation, and inadequate hygiene care.