Failure to Honor Resident Shower Preferences and Promote Self-Determination
Penalty
Summary
The facility failed to promote and facilitate resident self-determination by not honoring reasonable shower preferences for three residents. Observations, interviews, and record reviews revealed that these residents, all of whom had no cognitive impairment and required partial to moderate assistance with bathing, did not consistently receive showers according to their stated preferences or care plans. Documentation showed significant gaps between showers, with some residents going up to 13 days without a shower, despite care plans indicating a preference for two showers per week on specific days. There was no documentation of resident refusals or additional showers provided. Interviews with the affected residents confirmed that they felt dirty, had oily hair, and experienced discomfort such as itching and skin issues due to infrequent bathing. One resident with cellulitis reported that infrequent showers led to skin cracking under abdominal folds. All three residents expressed a desire for more frequent showers and indicated that their preferences were not being met, often receiving only one shower per week instead of the two specified in their care plans. Staff interviews corroborated these findings, with CNAs and LPNs acknowledging that residents were not receiving the required number of showers due to staffing shortages and turnover among shower aides. Staff reported being pulled to other duties, which resulted in missed showers, and confirmed that residents had voiced concerns about the lack of regular bathing. Management was aware of these concerns, and staff were unsure how many showers residents actually received each week, despite a process for reviewing shower sheets.