F0677

D

Failure to Provide and Document Scheduled Showers/Bed Baths for Dependent Residents

Katy, Texas Survey Completed on 01-21-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure dependent residents received scheduled showers or bed baths three times weekly to maintain grooming and personal hygiene. For one female resident with acute respiratory failure, mouth cancer, pulmonary fibrosis, tracheostomy, PEG tube, and total dependence for bathing, the admission MDS documented that she was always incontinent of bowel and bladder and required full assistance with showers/baths. Her care plan addressed ADL self-care deficits and incontinence care but did not include specific shower/bath interventions. During observation and interview, the resident communicated via a board that she only received a bed bath once a week and wanted at least two baths weekly; her family member reported having already spoken with the administrator about the issue. EMR shower task records for the prior 30 days showed only two entries, both marked “Not Applicable,” with no documentation of completed showers/baths or refusals on the dates she was scheduled to receive them. After survey exit, paper shower sheets provided by the facility showed bed baths on four dates, but these were not reflected in the EMR shower task documentation.

A second female resident with diverticulitis with perforation and abscess, type 2 diabetes, heart failure, splenic abscess, acute respiratory failure, ESRD on hemodialysis, PEG tube, colostomy, and dependence for showers/baths was also involved. Her admission MDS showed normal cognition, lower extremity impairment, wheelchair use, and dependence for showers/baths, with incontinence of bladder and shortness of breath with exertion, at rest, and when lying flat. Her care plan included a focus on ADL self-care deficits and incontinence, with an intervention specifying substantial/max assist with baths/showers. During observation and interview, the resident’s family member stated she had only received one bath so far and only after they requested it, and the resident stated she wanted at least two baths weekly to help prevent infections. Review of the shower sheet binder showed no paper shower sheets or refusals for this resident, and EMR shower tasks for the prior 30 days showed “No Data Found” despite her being scheduled for showers/baths three times weekly. After exit, paper shower sheets produced by the facility showed three bed baths, which again were not documented in the EMR shower task system.

A third male resident with a right hip fracture, atrial fibrillation, pacemaker, muscle weakness, gait and mobility abnormalities, and incontinence of bowel and bladder was also affected. His admission MDS documented normal cognition, lower extremity impairment, wheelchair use, and a need for substantial/max assistance with showers/baths. His care plan addressed ADL self-care deficits and incontinence, with an intervention specifying substantial/max assist with baths/showers. During observation and interview, he reported that his only complaint was not receiving baths three times a week, that he required bed baths because he could not walk, and that he did not remember the last time he had received one. EMR shower task records for the prior 30 days showed only four completed baths, with missing entries for other scheduled dates. The shower sheet binder contained only one paper shower sheet for the month documenting a bath on one date, with no other sheets or refusals. After exit, the facility provided additional paper shower sheets showing bed baths on two later dates, which were not consistently reflected in the EMR. Interviews with the DON and a CNA confirmed that showers/baths were expected three times weekly and that documentation should occur in the EMR, with paper sheets used primarily to note skin issues, but the records reviewed did not substantiate that scheduled showers/baths were consistently provided or documented for these residents.

Facility policies on Activities of Daily Living and Resident Rights stated that hygiene is to be maintained, showers and baths are to be scheduled with assistance provided, and residents are to be treated with dignity and respect in a manner that maintains or enhances quality of life, self-esteem, and self-worth. Despite these policies, the survey findings showed missing or incomplete documentation of scheduled showers/baths in both the EMR and paper shower sheets for three residents who were dependent or required substantial/max assistance for bathing and were incontinent. Progress notes for the review periods contained no documentation of refusals of showers/baths for these residents. The combination of resident and family reports, observation, and record review demonstrated that the facility failed to ensure that these residents received the necessary services to maintain personal hygiene and grooming as scheduled and as required by their conditions and care plans.