Failure to Provide Scheduled Showers and Hygiene Assistance for Dependent Resident
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically in maintaining grooming and personal hygiene, for a resident who was completely dependent due to paraplegia and other significant medical conditions. The resident, who had normal cognition and was dependent for all mobility and self-care, did not receive scheduled showers three times a week as required by his care plan for multiple weeks. Documentation showed missed or insufficient bathing during several specified weeks, and there was no evidence of the resident refusing these services during the period in question. Medical records indicated that the resident had a history of complete paraplegia, type 2 diabetes, heart failure, a stage 4 sacral pressure ulcer, neurogenic bowel, and neuromuscular bladder dysfunction. The resident was bedbound, required an indwelling catheter, and was admitted with multiple pressure ulcers. Despite these needs, the resident reported only receiving bed baths at most once a week and denied ever refusing care or requesting it at times when staff could not accommodate. Observations noted poor grooming, including long yellow nails and an untrimmed beard, and the resident expressed a desire for grooming assistance that was not offered. Interviews with facility staff revealed inconsistencies in the provision and documentation of showers and bed baths. Staff cited the use of a Shower Tech and CNAs for bathing duties, but could not provide consistent or complete records of care provided. The ADON and DON acknowledged expectations for regular hygiene care but were unable to produce documentation supporting that the resident received the scheduled showers or baths. The facility's own policy required assistance with ADLs for residents unable to perform them independently, including hygiene and grooming, but this was not consistently implemented for the resident in question.