Failure to Revise Care Plan and Document Alternative Interventions for Refusal of Showers
Penalty
Summary
The facility failed to review and revise the care plan for a resident who consistently refused showers, and did not implement or document alternative interventions as required. The resident, who had diagnoses including adult failure to thrive, anorexia, type II diabetes mellitus, muscle weakness, and lack of coordination, was dependent on staff for transfers, personal hygiene, and bathing. Despite being scheduled for showers on specific days and shifts, documentation showed that the resident was not provided showers on multiple occasions over several months, with no follow-up documentation explaining the missed showers or indicating whether the resident had refused them. Interviews with nurse aides revealed that the resident had been refusing showers since admission but would accept bed baths instead. The aides reported notifying charge nurses when the resident refused showers, but these refusals were not documented in the clinical record. Additionally, the care plan was not updated to reflect the resident's ongoing refusal of showers or to include specific interventions addressing this behavior until after a family-initiated care conference. The shower schedule itself was inconsistent and confusing, listing showers for multiple shifts and days, which did not align with the actual care provided. Facility policy required that the comprehensive care plan be person-centered, include measurable objectives, and be updated to reflect refusals of care and alternative interventions. The policy also required documentation of attempts to provide care and discussions with the resident or their representative. However, these requirements were not met, as the care plan was not promptly revised, alternative interventions were not documented, and staff responsible for carrying out interventions were not adequately informed of changes.