Failure to Provide and Accurately Document Scheduled Bathing for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide scheduled bathing and to document refusals or completed baths for two residents who required assistance with activities of daily living. Facility policy required staff to provide bathing services per standard practice and to document refusals in the record. For one resident with severely impaired cognition, a BIMS score of 7, and no history of rejecting care, CNA flow sheets showed showers only on two Sundays within a two‑week period, despite the resident being scheduled for showers on Tuesdays and Fridays. Interdisciplinary progress notes contained no documentation of shower refusals, and the resident’s family member reported the resident only received showers after they complained to staff. For a second resident with intact cognition (BIMS 14), polyneuropathy, anxiety disorder, depression, and bilateral upper and lower extremity impairments, assessments showed the resident required substantial to maximum assistance with showers/baths and personal hygiene and was dependent for tub/shower transfers and non‑ambulatory. Physician orders specified bath days twice weekly on first shift. The TAR for a specific month showed the resident did not receive a bath on one scheduled bath day, while the MAR for the same date was initialed by an LPN as if a bath had been given. Nurses’ notes for that date contained no documentation of a bath being provided or refused. Multiple staff interviews confirmed that scheduled showers were not consistently completed for all residents and that there were no bath sheets for the second resident over several days at the end of the month. A CNA reported the second resident stated they had not had a shower for two weeks and that aides told the resident there was not enough staff to bathe all residents. Nursing staff, including CNAs, LPNs, the ADON, and the DON, described a process in which CNAs should notify nurses of refusals, and nurses should document refusals and notify family and physicians, but review of the electronic health record and bath documentation showed no evidence that this process was followed for the missed bath date. The second resident stated they did not receive a bath over several consecutive days and reported being told by aides that staffing shortages prevented all residents from being bathed.
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