Failure to Provide Scheduled Showers and Inadequate Documentation for Two Residents
Penalty
Summary
The facility failed to ensure that two residents who were unable to carry out activities of daily living (ADLs) received necessary services to maintain good hygiene, specifically in the area of showers and bathing. One male resident with a history of hypertension, kidney disease, UTI, and stroke did not receive showers or bathing for an 11-day period. Documentation showed scheduled shower days, but several dates were either not documented or marked as refused, with no corresponding nurse notes to confirm refusals. Interviews with staff revealed inconsistent accounts regarding refusals, and the resident himself denied refusing showers, stating he requested them daily but was not provided with one except on two occasions. The resident's family also reported daily complaints about missed showers, which were not addressed as grievances by facility administration. A second female resident with moderate cognitive impairment and physical limitations did not receive showers or bathing for a 14-day period. Documentation in the care plan and point of care system indicated multiple refusals, but there was no supporting nurse documentation for these refusals during the period in question. The resident reported missing several showers and expressed frustration, while her family had also complained. Staff interviews indicated that refusals were documented in the point of care system, but not consistently communicated to nursing management or documented in nurse notes as required by facility policy. The resident's physician was not notified of the missed showers, and the care plan included a negotiated risk agreement for refusals, but alternatives and follow-up actions were not documented. Throughout the period of deficiency, there was a lack of consistent documentation and communication regarding missed showers and resident refusals. Nursing staff did not consistently notify the physician, responsible party, or administration about patterns of missed showers, and there was no evidence of follow-up to determine the reasons for refusals or to update care plans accordingly. The facility's policy required documentation of ADLs provided or refused, but this was not adhered to, and the administrator was unaware of the issues until notified by surveyors.