Failure to Provide Consistent Bathing and Grooming for Multiple Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide consistent bathing and grooming for multiple residents who required assistance with activities of daily living. One resident with Alzheimer’s disease, anxiety, and atrial fibrillation had a BIMS score indicating moderately impaired cognition and required staff assistance with showers and personal hygiene. Her care plan directed staff to assist with bathing using a shower chair. However, shower records showed she did not receive a bath or shower for extended periods in March and early April, with only a few refusals documented despite staff statements that she frequently refused. Observations noted stained clothing and multiple chin hairs, and interviews with CNAs and nursing staff revealed inconsistent documentation practices and uncertainty about what happened to shower sheets after they were completed. Another resident with benign prostatic hyperplasia, major depressive disorder, and polyneuropathy had intact cognition and required supervision with showers and personal hygiene. His care plan documented a preference for staff-assisted shaving and two showers per week on specific days. Monthly shower sheets and bathing records for February and March lacked documentation that he received the requested twice-weekly showers and did not show refusals. During observation, he was unshaven and reported not receiving showers as requested, stating staff told him he had refused, but he was unable to review any signed refusal documentation. Staff interviews indicated he did not typically refuse showers and suggested that the bath aide was sometimes reassigned to floor duties, which may have contributed to missed showers. A third resident with dementia and a history of cerebral infarction had severely impaired cognition, relied on staff to meet daily needs, and required total assistance for personal hygiene per MDS and care plan documentation. Care plans directed staff to assist with grooming and hygiene to the extent needed. On multiple observations over two days, this resident was noted to have several chin hairs approximately 0.25 inches long and fingernails with a brown substance underneath and jagged edges, with no change after morning care was provided. Interviews with CNAs and a nurse revealed inconsistent understanding of responsibilities for shaving and nail care, with some CNAs reporting they were taught not to shave residents and that nurses cut nails, while the administrative nurse stated CNAs were expected to file, clean, and trim fingernails (except for diabetic residents) and remove facial hair on shower days and as needed. These findings conflicted with the facility’s Quality of Life–Activities of Daily Living policy, which required necessary care and services to maintain residents’ grooming and personal hygiene.
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