Failure to Honor Resident Bathing Preferences and Schedules
Penalty
Summary
The deficiency involves the facility’s failure to honor residents’ stated bathing preferences and schedules, as required for resident choice and self-determination. For Resident 2, who had a history of stroke with right-sided hemiplegia and hemiparesis, the quarterly MDS documented moderate cognitive impairment and dependence on staff for bathing and shower transfers. The resident’s preference care plan indicated a desire for showers twice a week before breakfast. However, v2 documentation showed inconsistent intervals between showers, including gaps of seven, eight, nine, and ten days between showers, and there was no documentation that a shower was re-offered after a refusal on one date. Observations over two days showed the resident repeatedly lying in bed in a hospital gown with disheveled hair. Resident 3, a long-term care resident with no cognitive impairment and dependent on staff for showers, had a care plan preference for two showers per week. Documentation for November and December showed some weeks where the interval between showers extended to six or seven days. In late December, showers were documented on two dates only. In January, the v2 report showed showers on three dates with seven and eight days between some showers. During an interview and observation, the resident, seated in a wheelchair and dressed, stated a preference for twice-weekly showers and reported they “barely get one a week.” Resident 4, also a long-term care resident, had an annual MDS indicating they could make their needs known and required substantial assistance for bathing. Their preference care plan documented a preference for two showers per week. In an interview, the resident reported they were bathed on Tuesdays and Fridays but stated it had been eight days since their last shower. The resident also reported that during a recent doctor’s appointment, a family member told them they smelled like urine, which the resident described as embarrassing, noting their limitations from using a wheelchair. Staff interviews confirmed that resident bathing preferences were obtained on admission and placed on care plans, and that NACs and shower aides were expected to document showers and refusals in the EMR and notify licensed nurses of refusals, but the documented shower frequencies did not consistently align with the residents’ stated preferences.
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