Failure to Provide and Document Scheduled Hygiene, Shaving, and Showers
Penalty
Summary
The deficiency involves the facility’s failure to provide and document necessary activities of daily living (ADL) care, specifically hygiene, shaving, and showers, for a resident who was unable to perform these tasks independently. The resident had vascular dementia, heart disease, and diabetes, with a Minimum Data Set showing moderately impaired cognition and a need for staff assistance with showering and personal hygiene, and no documented rejection of care. The comprehensive care plan and CNA Kardex specified weekly evening showers on Mondays and weekly facial hair removal with an electric razor, with staff to assist. Observations on two separate days showed the resident with several days of beard growth and later with one-quarter to one-third inch facial hair across the entire face, and the resident reported being due for a shave and shower and stated they had not received a shower. Record review of the Personal Hygiene Support Provided report from early February through mid-March showed no documentation of hygiene care on three specified Mondays, and the Treatment Administration Record showed no showers documented for the resident over a 17‑day period. There was no documentation in the electronic health record, including POC entries or nursing progress notes, that hygiene care was provided, refused, or reattempted on the identified dates, and no evidence that staff identified or followed up on missed hygiene care. Interviews with a CNA, an LPN, the RN Manager, and the DON revealed expectations that CNAs check the Kardex, reattempt care, notify nurses of refusals, and that missed care be reported and documented, but also showed that the CNA did not know where shaving care was documented and that nurses would only provide shaving or hygiene care if time allowed or by asking the next shift. These actions and inactions resulted in the resident not receiving scheduled hygiene care and the facility not ensuring completion, documentation, or reattempts when care was missed.
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