Failure to honor a resident’s shower preference: A cognitively intact resident who required assistance with showering and personal hygiene reported receiving only one shower per week instead of the at least two showers desired. Shower records showed irregular shower intervals, and staff interviews confirmed the assigned shower aide was too busy to provide the preferred frequency, while other CNAs did not give showers. The DON and ADON said residents should receive at least two showers weekly and have a choice, but the Administrator stated there was no shower-frequency policy.
Failure to Honor Resident Shower Preferences: The facility did not consistently promote resident self-determination when three cognitively intact residents who needed help with bathing did not receive showers at their preferred frequency. Shower records and interviews showed residents were often bathed about every two weeks instead of the twice-weekly schedule staff described, and refusals were not consistently documented. One resident reported needing a shower to feel clean because of sweating, another said he/she did not want to smell and had oily hair with visible flaking, and a third said he/she preferred two showers per week to avoid feeling dirty and worried about body odor.
Failure to Honor Residents’ Preference to Sleep In: Staff did not honor two residents’ stated preference to remain in bed later in the morning. One resident was cognitively intact and said staff forced him/her to get up early every day despite repeated requests to sleep in; the other resident was cognitively impaired, on hospice, and said staff woke him/her very early and made him/her sit in a wheelchair for hours before breakfast even after daily refusals. The DON acknowledged residents should not be forced to get up and that both residents would stay in bed if allowed.
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.
A resident and the resident council reported that fresh fruit listed on the breakfast menu was no longer being served, with only canned fruit offered instead. Staff observations and interviews showed no fresh fruit in the cooler, and dietary staff said ordering was limited by corporate pushback and budget cutbacks. The RD stated that if fresh fruit was on the menu, it should have been ordered and served, while the Administrator said he/she was not aware of the residents' requests.
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.
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