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 six residents. Multiple residents, all of whom were cognitively intact and had varying degrees of physical impairment, reported not receiving showers according to their preferences or the facility's stated schedule. Documentation was inconsistent or missing, with shower sheets unavailable for certain months and staff failing to record refusals or re-approach attempts. Residents expressed uncertainty about when they last received a shower and indicated a desire for more frequent showers, typically at least twice per week, which was not consistently provided. Care plans for several residents did not include individualized shower schedules or preferences, and in some cases, staff did not follow the preferences that were documented. For example, one resident preferred showers only from male staff, but there was no evidence that this preference was consistently accommodated. Another resident preferred showers on specific days or with certain staff, but reported that staffing shortages prevented these preferences from being met. Several residents went extended periods—sometimes weeks—without a shower, and some received only bed baths or brief changes, which they felt were inadequate for personal hygiene. Interviews with staff, including CNAs, CMTs, LPNs, and the DON, revealed that staffing shortages and the lack of a dedicated bath aide contributed to the inability to provide showers as scheduled. Staff acknowledged that residents were not consistently receiving two showers per week and that documentation of showers and refusals was incomplete. The facility did not have a shower policy available for review, and the process for offering and documenting showers was inconsistently followed, leading to unmet resident preferences and needs.