Failure to Provide Scheduled Showers and Hair Care for a Cognitively Intact Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate ADL care, specifically bathing and hair care, to a cognitively intact resident despite an existing ADL policy and individualized care plan. The facility’s policy required a consistent and effective approach to ADL care, including bathing, hygiene, hair care, and regular monitoring and documentation of ADL needs and outcomes. The resident’s ADL care plan, initiated shortly after admission, identified a need for assistance with ADLs due to weakness and decreased mobility following a recent hospitalization, and directed staff to encourage and assist with all ADL tasks, including bathing and personal hygiene, while observing for changes in capabilities. Record review showed that the resident was admitted with COPD, hypertension, GERD, and epilepsy, and had a BIM score of 14, indicating intact cognition. The resident was scheduled on the unit’s shower list to receive showers three times per week, but the computerized CNA task section for weekly showers/skin observation and the paper shower schedule form were left blank and not completed. CNA documentation reflected only three refusals for personal hygiene tasks such as combing hair and washing face and hands, and did not include refusals for baths, showers, or oral hygiene during the resident’s stay. There was no documentation in nursing progress notes, behavior monitoring records, or the ADL care plan of any refusals or behavioral issues related to showering or hair washing. Interviews and observations further demonstrated that the resident did not receive the scheduled showers and hair care. The resident and a relative reported that the resident had not received a full body bath/shower or hair wash since admission, and the relative stated that the lack of hair washing for 21 days was very distressing. On observation, the resident’s hair appeared oily with a dry scalp, and the resident reported an itchy scalp. Therapy staff described the resident as alert, oriented, and participatory in care, with some weakness and shortness of breath but able to perform grooming with standby assistance and other ADLs with varying levels of assistance. CNAs acknowledged that the resident should have been showered at least three times per week, admitted they had not provided showers or hair washes, and had not documented refusals or notified nursing. Nursing staff, including the unit manager, confirmed there was no documentation of refusals or care issues, and the DON acknowledged the resident should have received appropriate ADL care.
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