Failure to Revise Care Plan for Repeated Shower Refusals
Penalty
Summary
The deficiency involves the facility’s failure to review and revise a resident’s comprehensive care plan to address ongoing refusals of showers. A male resident with diagnoses including hypertension, diabetes, Alzheimer’s disease, anxiety, depression, malnutrition, and diaper dermatitis was admitted in mid-January 2026. His quarterly MDS showed a BIMS score of 11, indicating moderately impaired decision-making, and documented no behaviors under the behavior section. Functionally, he required varying levels of assistance with ADLs, including maximal assistance for shower/bath and personal hygiene, and was incontinent of bladder with a colostomy. Despite these needs, his care plan dated late December 2025 did not include any problem, goal, or interventions related to shower or bathing refusals; it only reflected that he was to receive showers/bed baths at least twice per week as documented on shower sheets and CNA point-of-care tasks. Surveyor review of progress notes and shower sheets showed multiple instances where the resident refused showers and requested bed baths instead, with refusals documented on several specific dates in early January 2026. During observation, the resident was alert, oriented, able to make his needs known, and appeared groomed with no lingering odor. In interviews, he reported having problems getting a shower, stating that he usually received a bed bath but wanted a shower where staff could soap him up and wash him off, which he felt could not be done in bed. He also stated that he was bathed but not as often as he would like, that he had specific bathing days but did not always receive them when he wanted, and that he expected staff to know when he wanted a shower. Staff interviews confirmed awareness of the resident’s pattern of refusing showers. The MDS Coordinator acknowledged knowing that the resident often refused showers and stated it should have been addressed in the care plan, characterizing its omission as a human oversight. A CNA described that the resident would initially agree to a shower, be placed in the shower chair, then start screaming and yelling that he did not want a shower and preferred a bed bath, after which he would call his daughter and say he did not get a shower. ADONs reported they were aware the resident always refused showers and believed he was care planned for shower refusals, explaining that he would be placed on the shower bed, then refuse to go to the shower room and request a bed bath instead, and later call his daughter stating he needed a shower. The facility’s own care plan policy required ongoing assessment and revision of care plans as resident conditions or information changed, and for the IDT to develop a comprehensive, person-centered care plan with measurable objectives and timeframes, but this was not carried out for this resident’s shower refusal behavior.
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