Failure to Provide/Offer Showers per Resident Preference and Inadequate Bathing Documentation
Penalty
Summary
The deficiency involves the facility’s failure to provide or offer showers according to a resident’s stated preferences and to maintain proper hygiene. Resident B, who was cognitively intact and required substantial staff assistance for lower body dressing, footwear, bathing, shower transfers, and toileting hygiene, had care plans indicating a need for one staff to assist with a.m./p.m. care, dressing, and bathing. A specific choices care plan documented the resident’s preference for showers on Tuesday and Friday day shifts, and there was no indication in the care plan that the resident was noncompliant with bathing. The resident also had unhealed pressure ulcers, a surgical wound, and MASD, with interventions that included education and reminders regarding good hygiene and daily changing of clothing and undergarments. Review of bathing documentation showed multiple dates on which the resident either refused or had no recorded bathing activity despite the established shower schedule. On some scheduled shower days, refusals were documented (e.g., certain Tuesdays and Fridays), but the clinical record did not contain any documentation of additional attempts, resident education, or notification of a nurse or family regarding these refusals. On several other scheduled shower days, the bathing record was left blank, with no indication that bathing was offered or provided. This lack of documentation made it impossible to determine whether the resident was actually offered showers in accordance with his preferences on those dates. Interviews with staff further highlighted inconsistencies between the resident’s documented refusals and staff recollections. CNA 3, who was assigned to the resident on the day he went to a community appointment, described the resident as pleasant, cooperative with care, and compliant with toileting and daily cleaning and dressing, and was unsure if the resident refused showers. Other staff, including QMA 4 and QMA 5, stated that residents were to be offered bathing according to their preferences, that refusals required multiple re-approaches and nurse notification, and that it was not acceptable to leave bathing or refusals uncharted. The DON acknowledged that there was no additional information available to show the resident’s bathing on the dates with blank documentation and that the record lacked any nurse or family notification regarding shower refusals, resulting in an inability to verify that showers were offered as required by the resident’s care plan and facility policy.
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