F0677

E

Failure to Provide and Monitor Scheduled Bathing and Hygiene Care

Greenville, Texas Survey Completed on 01-21-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that residents who were unable to fully perform activities of daily living received necessary services to maintain good nutrition, grooming, and personal and oral hygiene, specifically related to routine bathing and showers. For Resident #1, records showed she was cognitively intact with a BIMS score of 12, had no range of motion impairment, and required supervision with bathing. Her care plan directed staff to provide shower care per schedule and as needed, with no indication of routine refusals. She was scheduled for showers on the day shift three times weekly, yet multiple dates over several weeks had no completed shower sheets, and the electronic medical record bathing task did not indicate whether she received a bed bath or shower. On observation and interview, she reported not receiving a shower that day, could not recall her shower schedule or last shower, and her hair appeared matted and greasy.

Resident #2 had severe cognitive impairment with a BIMS score of 6, required moderate assistance with bathing, and had a care plan directing staff to provide showers per schedule and as needed. His care plan also included a behavioral focus for rejection of care, with a goal that he would remain clean and well-groomed. He was scheduled for showers three times weekly on the day shift. The shower assignment sheets showed only two documented showers and one refusal over the review period, with multiple scheduled days lacking any completed shower sheet. The electronic medical record bathing task again did not specify whether a bed bath or shower was provided. During interview, he stated he did not get a shower that day, believed his last shower was the previous day, and reported taking showers regularly with no specific schedule preference. Observation noted he was unshaved, had an unkempt appearance, matted hair, and an unclean odor.

Resident #3 was cognitively intact with a BIMS score of 12, had no extremity impairment, and required supervision or substantial/maximal assistance with bathing according to the MDS and care plan. Her care plan required staff to provide showers per schedule and as needed, with no indication of bathing refusals. She was also scheduled for showers three times weekly on the day shift. The shower sheets showed one documented shower and two refusals, with numerous scheduled days lacking any completed shower sheet. As with the other residents, the electronic medical record bathing task did not indicate whether a bed bath or shower was actually given. In interview, she stated she did not receive or was not offered a shower that day and believed her last shower had been a couple of weeks earlier; observation showed her hair was disheveled and unclean in appearance.

Staff interviews revealed systemic issues with the shower documentation and monitoring process. Multiple CNAs stated there was a shower schedule posted at the nurses’ station and that they were to complete shower sheets after each shower and turn them in to the nurse, including documenting refusals and skin concerns. Several CNAs acknowledged that sometimes they were not able to complete all scheduled showers and did not know if showers were completed on subsequent shifts, and none could explain why multiple shower sheets were missing for the three residents or confirm that showers had been provided. LVNs reported that shower sheets were important for proof of completion and for identifying skin changes, and that they were responsible for reviewing the sheets and being notified of refusals, but they also could not explain the missing documentation or confirm that showers occurred. The DON and Administrator stated their expectation that showers be completed per schedule, refusals reported to nursing, and shower sheets completed and monitored by nursing and management, but the missing shower sheets and resident reports and observations demonstrated that these expectations were not met for the three residents.

The facility’s own Clinical Practice Guidelines for Activities of Daily Living Care stated that residents will receive essential services for ADLs to maintain grooming and personal and oral hygiene, and that bathing includes grooming activities such as shaving and brushing teeth and hair. Despite these guidelines and the established shower schedules and care plans, the lack of completed shower sheets on multiple scheduled days, the absence of clear documentation in the electronic medical record regarding whether showers or bed baths were provided, and the residents’ own statements and observed unkempt conditions show that the facility did not ensure that these three residents were routinely showered or bathed as planned. This combination of incomplete documentation, staff inability to verify that showers were given, and observed poor hygiene constituted the deficiency in providing necessary ADL care for bathing and grooming.