Failure to Honor Resident Bathing Preferences and Provide Daily Bathing as Care Planned
Penalty
Summary
The deficiency involves the facility’s failure to honor a cognitively intact resident’s stated bathing preferences and to provide or offer daily bathing assistance as care planned. Facility policy on Resident Shower and Bathing requires that residents receive assistance for bathing and showering in accordance with their care plans, with personal hygiene needs met and preferences honored. The resident was admitted with multiple diagnoses including pulmonary edema, chronic respiratory failure with hypoxia, lack of coordination, central corneal ulcer, and generalized muscle weakness. A recent MDS showed a BIMS score of 15/15, indicating intact decision-making ability. The resident’s comprehensive care plan identified a self-care deficit related to osteoporosis, unsteadiness, generalized muscle weakness, gait abnormalities, and pre-glaucoma, with a goal that the resident would be neat, clean, and dressed daily, and an intervention directing staff to complete a shower/tub/bed bath daily and PRN. The care plan did not document any pattern of bathing refusals. Despite this, review of shower and bath documentation showed that the resident was not offered and did not receive any type of bath on Fridays, Saturdays, and Sundays in August and September, had only two days of documented baths or offers in October, and only six days of any type of bath documented in November. There was no documentation that the resident refused daily baths or showers. The resident reported not receiving needed assistance to bathe, stated that Fridays were her preferred shower day and that if she did not get a shower on Fridays no other type of bath was offered, and that she was told she was not on the list when she requested bathing on Saturdays, with no baths or showers offered on Sundays. She also stated that most days she was not offered any type of bath and that it depended on which staff were working. The Administrator acknowledged that refusals were marked on the report but that many of the notations reflected that the resident had already received a bath that day, and the surveyor noted concern about days with no documentation of an offer or provision of bathing. A CNA stated that residents are supposed to receive bed baths seven days a week and showers two days a week, and that refusals must be offered and documented, underscoring that the expected practice was not consistently followed for this resident.
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