Failure to Notify Responsible Party of Resident's Repeated Refusals of Bathing
Penalty
Summary
The facility failed to notify the responsible party (RP) of a resident who lacked capacity to make medical decisions about the resident's repeated refusals of showers and complete bed baths. The resident, who had diagnoses including schizophrenia, traumatic subdural hemorrhage, major depressive disorder, and metabolic encephalopathy, refused seven out of eight showers or complete bed baths over a one-month period. The care plan for the resident specifically required that the medical doctor and RP be notified in cases of non-compliance, and the facility's policy and procedure (P&P) on refusal of treatment required documentation of the refusal, the resident's response, education provided, and notification of the RP. Despite these requirements, there was no documentation in the resident's progress notes indicating that the RP was notified of the refusals. Interviews with facility staff, including a registered nurse and the Director of Nursing, confirmed that the care plan and P&P were not followed, and that the refusals and subsequent notifications were not properly documented. The lack of notification resulted in the RP being unaware of the resident's hygiene needs and refusals of care.