Failure to Honor Grooming Preferences and Dignity for Cognitively Impaired Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide care in a respectful and dignified manner to a dependent, cognitively impaired resident when staff shaved off his beard without consideration of his preferences or those of his representative. The resident had diagnoses including dementia with psychotic disturbances and failure to thrive, and his Baseline Care Plan documented poor communication and comprehension but did not address his grooming or beard-maintenance preferences. Upon admission, he required total assistance with hygiene after a bowel movement, indicating dependence on staff for personal care decisions. Progress notes show that the resident’s family later contacted the facility to express that they were upset because staff had shaved off his beard. The family reported that his beard was part of his identity, was well cared for, and that they and his grandchildren did not initially recognize him without it. They stated that the resident, due to dementia, would not recognize himself in the mirror and that they felt he had been stripped of his dignity and identity. The family reported being told by staff that the beard was shaved because there was food in it and that staff claimed they had tried to call but had the wrong number. Interviews with staff revealed uncertainty and gaps in practice regarding obtaining and documenting resident preferences, particularly for residents with dementia. A CNA and a licensed nurse both stated they did not recall the resident and were unclear about who was responsible for obtaining preference information at admission, though they acknowledged that such information should be collected from residents or representatives. The social services staff member stated she did not ask about shaving preferences and did not know if consent was required to shave a resident with a full beard, but acknowledged that preference information for ADLs should be obtained and that a grievance had been filed about shaving the resident without contacting the representative. Administrative staff confirmed that residents’ and representatives’ histories and preferences should be incorporated into the care plan, especially for confused residents, and acknowledged awareness of the grievance about the beard being shaved without having responded to the reporter as of the survey date.
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