Failure to Provide Scheduled Showers and Bathing Assistance to Dependent Residents
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs), specifically showering and bathing, to multiple residents who were dependent on staff for these tasks. Record reviews, staff and resident interviews, and direct observations revealed that 12 residents did not consistently receive scheduled showers or appropriate documentation of bathing over a period of several months. In many cases, residents were scheduled for showers two times per week, but records showed only sporadic or single instances of showers or bed baths, with some residents going weeks without documented bathing. For example, one resident was scheduled for showers on specific days but only received one shower in a 30-day period, while another resident had no showers documented for two consecutive months. The affected residents had significant medical conditions and functional limitations, including end stage renal disease, hemiplegia, morbid obesity, chronic obstructive pulmonary disease (COPD), dementia, and quadriplegia, which made them dependent on staff for personal hygiene. Several residents were cognitively intact and able to report that they were not receiving showers as scheduled, while others were severely cognitively impaired and unable to advocate for themselves. Observations included residents appearing unkempt, with oily hair and signs of not having been bathed for an extended period. Documentation in both the facility's shower book and electronic medical record (EMR) was incomplete or missing for many scheduled showers, and staff interviews confirmed that showers were not always provided as required. Staff interviews revealed systemic issues contributing to the deficiency, such as inadequate staffing, lack of a dedicated shower aide on certain days, and unclear delegation of shower responsibilities when the assigned aide was unavailable. Staff reported being pulled to cover other duties, resulting in missed showers for residents. The facility's own policy required documentation of all showers, refusals, and interventions, but this was not consistently followed. The Director of Nursing confirmed that the available documentation accurately reflected the showers that were actually provided, indicating that the lack of care was not simply a documentation error but a failure to deliver the required assistance with ADLs.