Failure to Provide and Document Required Grooming and Shaving Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide and document necessary grooming and personal hygiene services, specifically shaving and facial hair care, for multiple residents who required assistance with activities of daily living. Facility policies required shaving male residents daily and women as needed, and indicated that licensed nurses and CNAs were responsible for implementing shaving procedures to improve appearance and morale. The DON stated facial hair was expected to be groomed at least on shower days, yet also acknowledged there was no designated area in the record to document grooming assistance and that refusals were expected to be documented in progress notes. One resident with Alzheimer’s disease, dementia, and depression had severe cognitive impairment and required maximum assistance with personal hygiene, including shaving per the care plan and CNA Kardex. Over a review period of several months, the electronic medical record contained no documentation that staff offered, provided, or recorded refusals of shaving or grooming, despite observations on multiple days showing long, patchy facial stubble and an overgrown mustache curling into the mouth. The resident’s family member reported that staff were expected to assist with shaving and that the resident did not like facial hair. A CNA and an RN manager both stated residents were shaved on shower days and acknowledged the resident required assistance and could be resistive at times, but there were no documented refusals. Another resident with a history of stroke, diabetes, and hypertensive heart disease was cognitively intact, visually impaired, and required substantial assistance with personal hygiene, including hair combing and shaving. The care plan and Kardex directed staff to assist with grooming, and ADL sheets showed grooming after set-up assistance with no refusals documented. This resident was repeatedly observed with long chin hair and facial hair on the upper lip and reported disliking facial hair, being unable to remove it independently due to impaired vision, and not refusing grooming care; the resident also stated staff had not offered assistance. A nurse manager confirmed the resident did not refuse care and that staff were expected to offer grooming assistance. A third resident with Parkinson’s disease, diabetes, and anxiety, cognitively intact and requiring moderate assistance with personal hygiene, had a care plan and Kardex directing staff to assist with shaving and trimming facial hair. Over several months, there was no documentation of grooming assistance or refusals, while observations showed a beard several inches long and a mustache curling into the mouth. This resident stated they wanted help trimming facial hair and that it had been months since grooming was last completed, while staff interviews revealed grooming was usually tied to shower days, often undocumented, and dependent on resident requests, despite the resident’s stated preferences.
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