Failure to Honor Resident Bathing Preferences and Document Shower Provision
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to self-determination and choice regarding bathing, specifically by not ensuring showers were provided consistent with the resident’s preferences. The resident, an older adult with diagnoses including severe sepsis with septic shock, pneumonia, major depressive disorder, and weakness, was cognitively intact with a BIMS score of 15 and required assistance with several activities of daily living. The MDS documented bathing as not applicable for assistance, while the ADL care plan initiated shortly after admission indicated the resident needed partial to substantial assistance for bathing or showering but did not include the resident’s bathing preferences or specific shower days. The resident’s representative reported that the resident stated staff were busy and not providing showers, and that the resident requested a shower during the week after admission but did not receive one. The representative observed the resident wearing the same clothing on multiple occasions and noted a personal female odor, and the resident expressed a desire to be clean. When the representative requested documentation of completed showers from the DON, the facility was unable to provide it. Review of the CNA bathing task documentation from admission through discharge showed no documented showers during the resident’s stay, and the electronic medical record revealed that the shower preference assessment was not completed upon admission. Staff interviews indicated that residents were scheduled for showers multiple times per week and could choose morning or evening showers, with refusals to be documented and communicated between shifts. A CNA stated that this resident was scheduled for showers three times weekly and sometimes refused due to fatigue after therapy, with refusals to be documented and missed showers potentially made up on subsequent days. An LPN described a process of repeated offers, documentation of refusals, and family notification if a resident refused showers. The DON stated residents were to be offered showers at least twice weekly, that a preference evaluation was part of the admission packet, and that new admissions were to be offered a shower the day after admission, but acknowledged staff reported they forgot to document offers or refusals and that she was unaware of any bathing concerns until after the resident had discharged. These findings collectively show that the facility did not ensure the resident’s shower preferences were assessed, care planned, and carried out in practice, nor consistently documented.
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