Failure to Honor Resident Choice and Independence During Bathing
Penalty
Summary
Surveyors identified a failure to honor a resident’s right to make choices and to promote independence in ADLs during bathing. On one occasion, a QMA reported that a CNA requested assistance with showering a resident and, during the shower, was rude and demanding. The CNA moved the resident into a corner away from the showerhead and, when the resident reached for the showerhead, told him he was not allowed to have it and that staff had been told he could not have it. When the resident again reached for the showerhead, the CNA and the resident engaged in a tug-of-war over it. The QMA stated she had never been told the resident could not have the showerhead and that this restriction was not in the resident’s care plan. The resident later reported being upset by the incident, identified the CNA involved, and stated that this staff member would not give him the showerhead, although he was not physically harmed and generally liked to do as much for himself as possible. Record review showed the resident had vascular dementia without behavioral disturbance, anxiety, and a history of cerebral infarction with impaired function on the left side, and was dependent for multiple ADLs including bathing, dressing, and transfers. The current ADL care plan directed staff to encourage the resident to participate to the fullest extent possible with each interaction and did not include any intervention restricting his use of the showerhead. The CNA assignment sheet for the date of the incident also lacked any indication that the resident should not be allowed to hold the showerhead. Behavior progress notes documented four prior instances in which the resident was not allowed to have the showerhead after asking for it. Other staff, including another CNA, the MDS Coordinator, and the DON, indicated they were unaware of any restriction and that the resident should have been or was allowed to have the showerhead, with some aides reportedly denying it because the resident had sprayed staff during showers. The facility identified this as a resident rights violation related to self-determination and dignity.
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