The facility failed to honor resident choice and self-determination regarding bathing by not consistently providing showers as expected and as important to residents. Several cognitively intact and impaired residents with significant ADL needs, incontinence, and mobility limitations reported going one to two weeks or longer between showers, despite stating they wanted and were supposed to receive two showers per week. Documentation showed prolonged gaps between showers without recorded refusals, while staff acknowledged ongoing problems with shower provision, short staffing, unclear assignment of shower responsibilities, and confusion over whether to document showers on paper or in the EMR. Leadership confirmed that showers should be offered twice weekly and that lack of documentation or "not applicable" entries meant showers were not given, yet the DON had not been reviewing shower records, resulting in residents feeling dirty, embarrassed, neglected, and concerned about body odor.
Failure to Honor Resident Shower Preferences: The facility did not honor shower preferences for three residents with significant care needs, including dementia, COPD, a catheter, and severe cognitive impairment. Shower records showed limited bathing, while progress notes did not document showers or refusals. One resident reported feeling dirty and wanting showers twice weekly, another appeared with oily hair and body odor, and a responsible party reported an unshaved resident with long toenails, poor oral care, and soiled clothing. The DON and Administrator said residents should be kept clean and preferences should be honored, but were unaware the residents were not receiving showers twice per week.
Failure to honor resident shower preferences and document refusals: two cognitively intact residents who needed bathing assistance were not shown to have received showers at the expected frequency, and care plans did not address bathing preferences. CNA shower review sheets and nurses' notes lacked documentation of showers or refusals, while CNA, LPN, DON, and the Administrator all stated residents should be offered showers at least twice weekly and refusals should be recorded.
Failure to Honor Resident Bathing Preferences: A cognitively intact resident who required substantial to maximal assistance with bathing had a documented preference for a daily bed bath, but bathing was provided inconsistently and not in line with that preference. The resident reported that hot water was unavailable on the unit and that staff did not offer showers or bed baths as expected; staff confirmed residents on the unit were not receiving bathing at least twice weekly because of cold water, and that the resident’s choice for daily bathing should have been honored.
The facility failed to honor a resident’s right to self-determination by not adequately promoting and facilitating resident choice, resulting in a repeated citation related to resident rights. The deficiency is linked to a prior uncorrected event and a subsequent complaint investigation, though no further clinical or resident-specific details are provided in the report excerpt.
Failure to provide hygiene care in accordance with resident preferences: Two residents who were cognitively intact and dependent on staff for bathing did not receive showers or bed baths as planned. One resident's showers were documented on days and times that did not match the care plan, and the resident reported going nearly two weeks without a shower. The other resident reported getting bed baths only about every other week, and observation found greasy, unkempt hair and a strong foul body odor. Staff said showers were assigned by room number, a shower aide was no longer available on days, and residents should have a choice of date and time.
A resident with hemiplegia, dysphasia, abnormal posture, and moderately impaired cognition repeatedly requested to get out of bed for meals, but staff relied on a get-up list that did not reflect the resident’s preference. The resident was observed eating breakfast in bed on multiple occasions, with the call light inaccessible and signs of difficulty positioning and eating, while staff said the resident was not consistently on the list and was often assisted up only after breakfast. Interviews confirmed staff knew the resident did not like being in bed, and an OT stated the resident’s choice about where to eat should be honored.
Failure to Document and Honor Resident Food Preferences: The facility did not consistently assess, document, or communicate residents’ food likes and dislikes in care plans or dietary cards. Multiple residents reported that staff never asked about their preferences, some said disliked foods were still served, and several were unaware of available substitutions. A resident alternative foods list was kept in the DM’s office but was not posted for residents to view.
A facility failed to honor resident choice by not providing a means for a cognitively intact resident with liver cancer to attend Saturday Seventh Day Adventist services, despite staff knowing the resident’s religious needs and no Saturday services being scheduled. The facility also did not post a substitute food list for meals for three residents, including residents with GERD, DM, dementia, depression, Parkinson’s disease, anxiety, seizure disorder, CAD, HTN, and depression; residents reported not receiving or seeing a list, and staff confirmed the substitute menu was not posted.
Failure to Honor Resident Shower Preferences: Multiple residents reported not receiving showers at their preferred frequency, and records showed showers were often limited to once weekly or spaced several days apart. One resident with CHF, morbid obesity, and depression wanted two showers per week but often received one; another resident with COPD, CKD, DM2, and ESRD wanted showers before dialysis but the schedule was driven by dialysis and staffing; a third cognitively intact resident said showers had been lax and that two per week were preferred. Staff interviews confirmed shower aides were sometimes pulled to the floor, and nursing notes did not document additional shower attempts or refusals.
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