Failure to Honor Resident’s Shower Preferences and Care Plan
Penalty
Summary
The deficiency involves the facility’s failure to provide bathing in accordance with a cognitively intact resident’s stated preferences and care-planned interventions. The resident, admitted with diagnoses including cellulitis of the left lower limb, peripheral vascular disease, and major depressive disorder, had a care plan dated 03/06/25 indicating an ADL self-care performance deficit related to impaired mobility and muscle weakness. Interventions included providing bathing and showering per the shower schedule and as requested, and offering a sponge bath when a full bath or shower could not be tolerated. Physician orders dated 03/20/25 documented that the resident required a two-person assist with a mechanical lift. A Quarterly MDS assessment showed the resident required substantial to maximal assistance with toileting hygiene and bathing, was dependent for transfers and getting in and out of a tub or shower, and did not reject care during the seven-day look-back period. Record review of shower sheets and aide charting from 12/08/25 through 01/08/26 showed missing documentation for 12/08/25 and 12/18/25, with no evidence the resident received either a shower or a bed bath on those dates. During this period, the resident received a mix of bed baths and showers, but not consistently per the posted shower schedule, which indicated showers on Monday and Thursday evenings. Progress notes from 12/08/25 through 01/08/26 did not show that the resident refused showers or requested bed baths instead. On observation, the resident reported she had not had a shower for three weeks and had only been given bed baths, and stated she wanted showers and did not care about the time of day. When questioned, an LPN and a CNA stated the resident was scheduled for evening showers on days that were not their shift and suggested she might not be getting showers because she required a mechanical lift and two staff, and there might not have been enough staff available. The facility’s resident rights policy stated that residents have the right to make their own schedule, participate in care planning, and participate in decisions affecting their care.
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