F0677

E

Failure to Provide and Document Scheduled Bathing and ADL Care per Resident Needs and Preferences

Independence, Missouri Survey Completed on 03-16-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to assess, care plan, provide, and document bathing and other activities of daily living (ADLs) in accordance with resident needs, preferences, and facility policy. The facility’s ADL policy required that residents who could not perform ADLs independently receive appropriate support with personal hygiene, including bathing, in accordance with the care plan, and that refusals be explained to the resident/representative, alternative interventions offered, and refusals documented. The facility also had a Skin Monitoring: Comprehensive CNA Shower Review form that required CNAs to visually assess skin during showers, document the type of personal care provided, obtain charge nurse and DON signatures, and document refusals with resident signatures or staff witnesses after multiple attempts. Surveyors found that these processes were not followed for multiple residents.

One resident with bilateral lower extremity amputations and a history of stroke required staff assistance for showering and had scheduled bath days twice weekly. The care plan identified a self-care performance deficit and need for assistance with showering, but the shower review form for one date only contained a CNA signature without documentation of the type of personal care provided or a charge nurse signature. The facility could not provide additional documentation that showers were provided twice weekly over a one‑month period, and electronic records only showed that the resident required assistance, not that showers were completed. This resident, who was cognitively intact and able to make needs known, reported needing assistance for all personal care and not receiving baths/showers twice a week, and could not recall the last shower.

Another resident with paraplegia, neuromuscular bladder dysfunction, and a suprapubic catheter had an admission care plan that noted a lack of patience for assistance but did not include an ADL care plan specifying the type of assistance needed for baths/showers or the resident’s bathing and personal care preferences. The admission MDS showed the resident was cognitively intact but had difficulty communicating needs, and the admission MDS and care areas had not been completed or submitted by the time of the survey. Shower review forms for this resident on two dates contained the wrong first name, only a CNA signature, no description of personal care provided, and no charge nurse signature. Documentation showed only two showers out of eight scheduled opportunities, with no additional records of showers or refusals over several weeks. The resident reported concerns about not receiving assistance with care and bathing, needing help with transfers, and having difficulty with speech and expressing needs.

Additional residents with muscle weakness, morbid obesity, mobility impairments, and dependence on staff for bathing also did not receive scheduled baths twice weekly, and their care plans lacked complete ADL/bathing interventions. One cognitively intact resident with upper and lower extremity impairments required substantial/maximal assistance for bathing but had no ADL care plan for cares. Paper bath sheets and EMR entries showed multiple missed baths over several weeks, with staff documenting “not applicable” instead of completed baths or refusals. This resident was observed with body odor, greasy uncombed hair, and reported not getting showers as scheduled and wanting evening showers, which staff did not provide due to staffing issues.

Two other cognitively intact residents, both with morbid obesity and mobility limitations, were dependent or substantially dependent on staff for bathing and had care plans indicating ADL self‑care deficits and total dependence for showers. Bath sheets and EMR documentation showed that each missed multiple baths out of scheduled opportunities, again with “not applicable” recorded instead of completed baths or refusals. These residents reported not getting baths regularly, attributing this to insufficient staff and the lack of a bath aide, and one resident stated a preference for bathing after pain medication due to stiffness and soreness, while another preferred evening or night showers and expressed dissatisfaction with messy, uncombed hair. Staff interviews confirmed that residents were supposed to receive two showers per week on assigned bath days, that preferences should be reflected in care plans or other tools, and that CNAs were responsible for documenting showers and refusals in both shower sheets and the EMR. The administrator, DON, LPN, CNA staff, and MDS coordinator acknowledged missing documentation, confusion between “not applicable” and refusal, incomplete ADL care planning, and delays in completing MDS and care plans, all contributing to the failure to ensure scheduled, documented bathing and individualized ADL care for the affected residents.