Failure to Care Plan for Bath/Shower Refusals and Assistance Needs
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to develop and update comprehensive care plans addressing residents’ refusals of baths/showers. One resident with intact cognition, paralysis on one side related to a stroke, and full dependence on staff for bathing had a care plan noting a self-care deficit, left-sided weakness, a history of refusing ADLs, and the need for staff assistance with bathing. However, the care plan did not include any interventions for refusals of bathing or showers. Weekly skin assessments over several weeks documented that this resident refused showers, and nursing assistants reported that the resident frequently refused showers, sometimes only allowing certain staff to assist, but these preferences and alternate shower times were not reflected in the care plan or medical record. Nursing staff acknowledged that the resident missed baths, had a history of refusals, lacked a risk/benefit form, and that the care plan did not contain interventions for staff to follow when refusals occurred. Another resident with intact cognition and diagnoses including traumatic brain injury, seizure disorder, heart disease, and lung disease had a care plan indicating a self-care deficit related to weakness but incorrectly documented the resident as independent with bathing and did not reflect the need for supervision or touch assistance. Weekly skin inspections over multiple weeks showed this resident refused showers, and during observation the resident appeared disheveled with body odor and reported not bathing weekly due to feeling physically weak, stating staff did not offer help or ask about showers and being unsure of the last shower. Nursing staff later acknowledged that the resident did not bathe weekly, had refused showers for four consecutive weeks, and had no documented independent showers during that period, and that the care plan lacked interventions to promote bathing when the resident refused or did not bathe independently. The DON stated that the expectation was for staff to conduct risk/benefit education, notify the provider and power of attorney, and try different approaches when residents refused baths, and that successful interventions should be added to the care plan and updated with changes, but confirmed this had not been done for these residents despite missed baths over several weeks.
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