Failure to Obtain HCPOA Consent for Atypical Personal Care
Penalty
Summary
The deficiency involves the facility’s failure to inform and obtain consent from a resident’s Healthcare Power of Attorney (HCPOA) before providing atypical personal care. The resident’s MDS documented severely impaired cognition, and the HCPOA (V4) later filed a grievance stating that the resident’s pubic hair had been shaved by a CNA without permission. During an examination with the DON (V2) and restorative staff (V17), the resident’s pubic area appeared recently shaved with approximately 1/4 inch hair regrowth. When asked, the resident indicated awareness that her pubic area had been shaved and indicated she did not want to have been shaved. Staff interviews revealed that a CNA (V5) reported a family member (V7) requested that the resident’s pubic hair be shaved so the resident would be “nice and clean,” and another CNA (V11) confirmed it was clear to them that V7 made this request. V5 stated she obtained razors and shaved the resident’s pubic area while V7 was out of the room. An LPN (V12) also stated that V7 had previously asked her to shave the resident’s pubic hair. V7, however, denied ever asking staff to shave the resident’s pubic hair and stated she knew only the HCPOA (V4) could make such care decisions. V4 stated she had never given permission for staff to shave the resident’s pubic hair and that, if trimming were needed, she would do it herself. Facility leadership (V2 and V14) stated staff were expected to check with the HCPOA before providing any special care requests outside typical services, consistent with the facility’s Resident Rights policy, but this did not occur in this case.
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