Failure to Address Shower Refusals and Maintain Call Light Accessibility
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident’s repeated refusals of scheduled showers were assessed, documented, and addressed in relation to the resident’s bathing preferences, and the failure to ensure another resident’s call light was kept within reach despite care plan requirements and facility policy. One resident was admitted with adult failure to thrive and a need for assistance with personal care, was cognitively intact, and able to understand and make needs known. The facility assigned shower days and times by room number, placing this resident on an evening/night schedule twice weekly, with instructions that CNAs report refusals to the charge nurse and obtain resident or guest signatures on shower sheets. The resident’s care plan identified ADL self-care deficits, need for assistance with showering, delirium, delusions, and known noncompliance with medical treatment. From early December through early January, the resident refused all offered evening/night showers on multiple assigned days. Documented reasons included that it was too late for a shower and a preference for morning showers. Some refusal entries lacked the resident’s signature, and there was no documentation on the shower sheets that refusals were addressed by licensed nursing staff or that the resident was educated about noncompliance with bathing. Review of the medical record for the same period showed no nursing documentation related to the repeated evening shower refusals and no new interventions regarding bathing preferences or changes to shower days/times. Although the care plan was updated to note a history of refusal of care, treatments, and medications, there were no added interventions specifically addressing shower timing or offering alternative shower schedules aligned with the resident’s stated preference for morning showers. The second deficiency concerns a resident with dementia, muscle weakness, difficulty walking, a need for assistance with personal care, and a history of falls, who required moderate to maximal assistance with self-care and mobility. Observations over several days showed this resident in bed or in a wheelchair with the call light consistently located behind the nightstand and not within reach. The resident reported that staff kept him/her in bed most of the time due to frequent falls and that night shift staff purposefully placed the call light out of reach, leaving the resident unable to get up independently to use the bathroom and having to wait until staff entered the room. The resident’s care plan required staff to ensure a safe environment by keeping the call light within reach, to encourage and educate the resident on using the call light for assistance, and to ensure it was within reach at all times. Despite staff interviews confirming knowledge of policies that call lights must be within reach and checked before leaving the room, repeated observations documented that this resident’s call light remained behind the nightstand and inaccessible.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.