Failure to Provide Bathing Assistance per Assessed Needs and Preferences
Penalty
Summary
The deficiency involves the facility’s failure to provide bathing assistance according to an identified resident’s assessed needs and stated preferences. During a lunch observation, the resident was seen with greasy, disheveled hair. In a Resident Council interview, the resident reported not receiving a shower for over a week, noted that her hair remained greasy and stringy, and that she was wearing the same clothes as the previous day. She stated that her scheduled shower days were Saturdays and Tuesdays, that she had not received showers on those days, that she was willing to shower at any time of day, and that she had never refused a shower. Record review showed the resident had diagnoses including anxiety, depression, and Vitamin D deficiency, and an annual MDS indicated she was cognitively intact, frequently incontinent of bowel and bladder, required partial to moderate assistance for bathing/showering, and that it was very important to her to choose between a shower, bed bath, or sponge bath. Facility shower sheets for March showed a shower on one Saturday and a complete bed bath with hair washed on one Tuesday, but the sheets for two subsequent scheduled shower days were blank except for the resident’s name and date. The DON stated that a blank shower sheet meant no shower had occurred. CNAs reported that blank sheets could mean refusal or that staff forgot to document, and that a sheet without a signature indicated a missed or ignored shower. Point of Care documentation for March showed frequent entries of partial bed baths (PBB) and multiple “activity did not occur” notations on various days, including on and around the resident’s scheduled shower days. CNAs explained that partial bed baths were used to document peri-care and that the electronic record only allowed peri-care to be recorded as a partial bed bath, making it unclear whether entries reflected full partial bed baths or only peri-care. One CNA described a partial bed bath as including face, armpits, and peri-area, while another described it as peri-area and legs, sometimes the back. The Administrator reported there was no facility policy specific to showering/bathing, and the only related written policy provided addressed general resident rights to dignity, well-being, and proper delivery of care.
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