Failure to Provide and Document Scheduled Bathing/Bed Baths for a Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident who was dependent on staff for ADLs received scheduled bathing/bed baths and that this care was properly documented. The resident was an adult male with COPD, depression, non-Alzheimer’s dementia, and diabetes, with an intact BIMS score of 15. His care plan, revised in late September, identified an ADL self-care performance deficit and specified that he required staff assistance for bathing, including provision of a sponge bath when a full bath or shower could not be tolerated. The November and December POC histories showed that the resident was scheduled for bathing/showers on Mondays, Wednesdays, and Fridays on the 6:00 AM–2:00 PM shift, with instructions to turn in a shower sheet to the charge nurse. However, in the Bathing task section for those days, the POC reflected “Not applicable,” and it was unknown from the records whether the resident received showers/bed baths or refused them. During observation and interview, the resident reported that he did not receive showers, preferred bed baths, and that his scheduled days were Monday, Wednesday, and Friday. He stated the last bed bath he recalled was some day the previous week, either Monday or Wednesday, and that he did not receive bed baths on his scheduled days. He further reported that when he requested a bed bath, staff told him they were short-staffed. The facility’s shower binder on the 200 hall contained no shower sheets for this resident, and requested shower sheets were not provided to the survey team before exit. Multiple staff interviews revealed inconsistent information and documentation practices. One CNA stated the resident’s shower days were on the 2:00 PM–10:00 PM shift and that he mostly refused bed baths, and that care was documented on shower sheets and in the POC, yet no shower sheets were found. Another CNA stated that if the POC showed “Not applicable,” it meant the shower was not provided and did not happen, and acknowledged she had not completed any shower sheets for this resident. A third CNA reported giving bed baths, last sometime the previous month, and stated that “Not applicable” in the POC meant the shower was not provided or offered. The assigned LVN stated the resident was provided bed baths on shower days but sometimes refused, and that staff documented on shower sheets and in the POC, though she could not explain the “Not applicable” entries. The ADON stated the facility was no longer using shower sheets and that staff should document in the POC, and acknowledged that based on POC documentation she could not prove the resident received any showers, adding that if it was not documented, it did not happen. The DON similarly stated she could not confirm from documentation that the resident received showers and that nurses in charge and the ADON were responsible for ensuring showers/bed baths were provided. The facility’s bed bath policy stated that complete bed baths are performed for residents on bedrest needing assistive care and may be done daily or alternated with partial bed baths, but the documentation and interviews did not substantiate that this resident’s scheduled bathing care was consistently provided.
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