Failure to Provide and Accurately Document Scheduled Showers for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a dependent resident received necessary assistance with activities of daily living (ADLs), specifically bathing and personal hygiene, as outlined in facility policy and the resident’s care plan. The resident, admitted with hemiplegia and hemiparesis following a cerebral infarction, epilepsy, and neuralgia/neuritis, had a BIMS score of 14 indicating no cognitive impairment but was documented as dependent for showering/bathing in the MDS. The resident’s care plan and Kardex required assistance from two staff for bathing/showering twice weekly and as needed. Facility policy required that all residents be offered a bath or shower at least weekly or per preference, and that refusals be reported to a nurse and documented by a licensed nurse. During an interview, the resident reported needing help with ADLs and stated that she previously received a shower every Monday but no longer did, estimating her last shower was about two weeks prior. She also expressed a preference for showers before 10:00 AM. On the same day, the surveyor found the resident’s call light not working for at least an hour while the resident was crying, needed changing, and requested ice water. Later that morning, staff were observed wheeling the resident back from a shower; afterward, the resident reported that the shower lasted about two minutes and that she was only rinsed with water. Review of the Point of Care (POC) bathing/shower documentation for the prior 30 days showed multiple dates on which the resident’s scheduled shower days were marked as “not applicable,” with no documentation that a shower occurred, and one date with a bed bath documented without explanation for why a shower was not provided. One date showed a refusal, but other scheduled shower days had no documentation of a shower or refusal. When the surveyor later compared printed POC shower documentation to what had been viewed onsite, there were discrepancies, including added check marks under “shower” on dates that had not previously shown showers. The facility did not provide documentation that the resident consistently received showers as care planned on all scheduled days, nor an explanation for the discrepancies in shower documentation or for the missed showers for a resident unable to perform ADLs independently.
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