Failure to Provide and Document Scheduled Showers and ADL Care
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident received showers and ADL care as planned and documented. Surveyors repeatedly observed the resident in the Memory Care unit with greasy, unkempt, and disheveled hair over several days. Review of the clinical record showed the resident had multiple significant diagnoses, including Alzheimer’s disease, paranoid schizophrenia, diabetes mellitus, severe protein-calorie malnutrition, vascular dementia, and other conditions. A recent MDS indicated the resident had both short- and long-term memory problems, moderately impaired cognitive skills for daily decision-making, and required partial assistance with bathing and showering. The care plan documented that the resident refused showers and required staff to explain tasks in detail, allow time to process, and continue to encourage care as tolerated. The care plan also specified assistance with ADLs, including offering showers twice weekly in the morning or early afternoon per the resident’s preference. Review of the EMR and shower sheets for a one-month period showed inconsistent provision and documentation of showers and shower attempts. The records showed a shower on one date in late January, a single documented refusal with no further attempts that week, and another shower at the end of January. In early February, there was one documented refusal with no further attempts that week, followed by three documented attempts on another date, a shower on a mid-February date, and three documented refusals on a later date. Nursing notes did not contain documentation of the resident’s refusals to shower during the review period. Interviews with staff indicated that the expectation was to attempt showers up to three times, then notify the nurse so the refusal could be documented in the EMR, but there was no explanation for why the resident was only offered or received one shower in certain weeks and why nursing notes lacked refusal documentation. The Regional Director of Clinical Services stated the facility did not have a policy for providing ADLs, including showers and baths.
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