F0677

E

Failure to Provide and Document Scheduled Showers per Care Plans and Resident Preferences

Youngstown, Ohio Survey Completed on 03-05-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide scheduled showers and bathing assistance according to resident care plans, physician orders, and stated preferences for multiple residents who required staff assistance. For one resident with major depressive disorder, hypertension, congestive heart failure, chronic kidney disease, and other conditions, the care plan required one-person assistance for bathing and use of a sit-to-stand lift, with showers scheduled twice weekly. Review of electronic shower documentation over a six‑month period showed that this resident received 21 showers and two bed baths out of 50 scheduled shower days, with only six refusals documented. Facility staff, including a CNA and an LPN, stated that showers were documented only in the electronic system and that if documentation was blank, the shower was not provided. The LPN and a corporate QA RN acknowledged that shower documentation had been an ongoing concern.

Another resident with vertigo, anxiety disorder, muscle wasting and atrophy, major depressive disorder, hemiplegia and hemiparesis following cerebral infarction, and muscle weakness had a care plan requiring two‑person assistance for bathing and a mechanical lift, with showers scheduled twice weekly. The annual MDS did not specify the level of assistance for showering/bathing, marking the item as not applicable. Review of shower records over a six‑month period showed this resident received eight showers and 11 bed baths out of 52 scheduled shower days, with only one documented refusal. The resident reported not receiving showers as often as desired. Staff interviews confirmed that showers were documented electronically, that documentation was problematic, and that if a shower was not documented, it was considered not done.

A third resident with Alzheimer’s disease, dementia with psychotic disturbance, adjustment disorder with anxiety, muscle weakness, and a history of repeated falls had a care plan for one‑person assistance with bathing and transfers, and the MDS indicated a need for substantial or maximal assistance with showering/bathing. This resident was scheduled for showers twice weekly but received nine showers out of 13 scheduled days with no refusals documented, and reported not getting showers as scheduled. Another resident admitted with a periprosthetic fracture around a left knee prosthesis required two‑person assistance and was to receive showers twice weekly, with a documented preference for specific days. Over a 93‑day period with 26 scheduled shower days, this resident received only nine showers/bed baths with one refusal documented and reported having only one shower in the past month. Despite an in‑service on shower documentation, subsequent records still showed missed scheduled showers without refusal documentation.

A fifth resident with severe cognitive impairment and multiple diagnoses, including major depressive disorder, GERD, generalized anxiety, aphasia, dysphagia, stroke, bone disorders, bradycardia, and obesity, had physician orders for showers three times weekly and a requirement to notify family if the resident refused. Progress notes indicated this resident often refused personal care, including showers and incontinent care. Review of CNA shower documentation over a six‑month period showed 79 scheduled showers, with 46 provided and three refusals documented. The resident’s daughter reported that the resident had not been receiving all ordered showers for several months. The Nurse Aide Supervisor verified that documentation did not show the resident received showers in accordance with physician orders. Across all five residents, the facility’s own policy stated that bath and shower frequency was to be based on resident preference as noted on the care plan, yet records and interviews demonstrated that scheduled showers and resident preferences were not consistently followed or documented.