Failure to Provide Scheduled Personal Hygiene Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to consistently provide scheduled personal hygiene care, specifically bathing, to dependent residents as required by their care needs and facility policy. One resident with metabolic encephalopathy, asthma, post–joint replacement aftercare, and difficulty walking was admitted in late January with an MDS indicating moderate cognitive impairment and a need for maximal assistance with showering and extensive assistance with other ADLs. Nursing documentation showed no showers during the first week after admission and only four documented showers over the following month, with multiple scheduled shower dates marked as “No” without any notation of refusal. There was no documentation of follow-up interventions, attempts to reschedule missed showers, or communication with the resident’s family regarding missed hygiene care. The resident’s spouse reported that, to his knowledge, the resident had only received two showers since admission and noted in writing that a scheduled wash had not occurred. A second resident, admitted with cerebral palsy, moderate persistent asthma, moderate protein-calorie malnutrition, and schizoaffective disorder, had an MDS showing no cognitive impairment but dependence for showering and toilet hygiene and maximal assistance for other ADLs. Review of shower task documentation, excluding a hospitalization period, revealed that the only recorded bathing from admission through early March was a single bed bath, with no refusals documented in the progress notes. The resident reported not having been bathed since admission except for that bed bath and stated that showers were scheduled twice weekly on night shift. An LPN confirmed that refusals should be documented as refusals rather than “No” and verified that the only documented bathing for this resident was the one bed bath. The facility’s ADL policy required provision of necessary services to maintain grooming and personal hygiene, including bathing, in accordance with the plan of care and based on MDS findings, but the documented care did not reflect consistent provision of scheduled hygiene services for these dependent residents.
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