Failure to Provide and Document Necessary ADL Hygiene Care
Penalty
Summary
The facility failed to ensure that a resident who was unable to carry out activities of daily living received necessary services to maintain good personal hygiene. The resident, admitted with dementia with agitation and care planned for an ADL self-care performance deficit related to limited mobility, was documented on the quarterly MDS as being dependent on staff for baths and showers. The plan of care specified scheduled shower/bathing/personal care on Mondays and Thursdays during the day shift. Task documentation showed repeated entries that the resident refused showers on multiple dates, while the resident reported wanting a shower but only receiving sponge baths. On observation, the resident stated she had not had a shower in the last few days, and her hair appeared oily and pungent. Interviews with CNAs, RNs, the Unit Manager, and the DON revealed that CNAs were expected to notify nurses when a resident refused a shower so the nurse could re-approach and document the refusal. CNA staff reported they would ask residents about showers and notify the nurse if the resident refused. Nursing staff stated they would educate residents, document refusals, and inform families, using the shower schedule to identify who needed showers. However, the Unit Manager confirmed that although CNAs had documented multiple shower refusals in the task system, there was no corresponding nursing documentation in the EMR indicating that nurses were aware of the refusals or had spoken with the resident. This pattern showed that the facility did not follow its ADL policy, which required providing necessary services to maintain good grooming for residents unable to perform ADLs.
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