Failure to Provide Required Showers and Honor Bathing Preferences
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents who required assistance with activities of daily living received showers or baths in accordance with facility policy and resident preferences. The facility’s written policy required that showers or bathing be offered at least twice weekly or per resident/resident representative preference, with schedules developed for each resident and refusals reported to licensed staff. Surveyors requested a shower schedule but none was provided. For one resident with moderate cognitive impairment, impaired mobility, and a care plan specifying limited assistance with showering twice weekly, documentation showed only one shower or bed bath in October, two in November, one in December, and a refusal in January. Observations over several days showed this resident with long, messy, greasy hair, strong body odor, and wearing the same clothes, and the resident reported receiving showers only every two weeks or once a month, citing limited shower room availability and needing staff assistance to access the shower room. Another resident, cognitively intact with renal failure, neurogenic bladder, and paraplegia, required substantial/maximal assistance with bathing and had a care plan indicating a preference for a daily bed bath. Documentation for November and December showed four showers or bed baths each month, and two in January. However, this resident reported that the water in the room had not worked for several months and that shower rooms on the unit did not have hot water, resulting in not being offered showers or bed baths and an inability to recall the last shower. The resident stated a preference for daily shower or bed bath and described an instance when an aide declined to take the resident to another unit for a shower or obtain hot water from another unit, instead documenting a refusal after the resident’s request for hot water was not accommodated. A CNA confirmed that residents on the unit, including this resident, were not being showered regularly due to cold water and were not consistently receiving at least two showers or bed baths per week. A third cognitively intact resident, dependent on staff for bathing and personal care, reported not taking showers lately because the water was cold and instead performing partial “whore baths” at the sink. Review of shower sheets over nearly three months showed 19 opportunities, with only one documented shower, nine bed baths, and nine refusals. Facility leadership, including the DON, ADON, and Administrator, acknowledged that showers or bed baths were to be offered at least twice weekly and that resident choices, including daily bathing preferences, should have been honored. They also acknowledged that some residents may not have received showers or bed baths twice weekly due to inadequate water temperatures, despite the possibility of taking residents to other units for showers or obtaining hot water from other units.
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