State Findings:
Based on observations, resident and staff interviews, and record review, the facility failed to provide showers as scheduled for two of 29 sampled residents (R) R#1 and R#43. This failure had the potential to impact residents’ quality of life negatively.
Findings include:
R#43 was admitted to the facility on [DATE] with a primary admitting diagnosis (Dx) of end stage renal disease (ESRD. The resident was admitted to hospice on 9/14/2022
Review of the most recent quarterly Minimum Data Set (MDS) assessment for R#43 dated 12/10/2022 documented Section- C, cognition-Brief Interview of Mental Status (BIMS) score of 99, indicating cognition severely impaired. Section G, functional status documented extensive assistance, two-person physical help for bathing, and personal hygiene.
Record review of the care plan for R#43 updated 7/15/2022 included a risk for actual skin breakdown, the risk for problems with the elimination of bladder and bowels (B&B), always incontinent, hospice services for palliative care related to terminal diagnoses-nursing aide as scheduled.
Record review of the documentation revealed R#43 received a bath on the following dates in September, October, November, December, and January 3, 2023, five were by hospice: 9/27/2022, 9/29/2022, 10/6/2022 by hospice, 10/18/2022 by hospice, 10/25/2022, 11/8/2022 by hospice, 11/10/2022 by hospice, 11/15/2022, 11/24/2022, 12/3/2022, 12/8/2022, 12/10/2022, 12/17/2022, 12/20/2022, 12/22/2022 by hospice, 12/29/22/2022, and 1/3/2023. Two bath sheets had resident refused with no date on the bath sheets.
R#1 was admitted to the facility on [DATE] with current primary diagnoses (Dx) of hypertensive heart and chronic kidney disease stage two.
Review of the most recent quarterly Minimum Data Set (MDS) assessment for R#1 dated 10/14/2022 documented section-C, cognition-Brief Interview of Mental Status (BIMS) score of 11, indicating mild cognition impairment; section-E, section-G, functional status documented extensive assistance for personal hygiene, limited assist for toileting, and total dependence one-person physical help for bathing.
Review of the care plan dated 1/10/2023 included self-care deficit-assist with activities of daily living (ADL) as needed, the risk for problems with the elimination of bladder and bowels, risk for actual skin breakdown, history of fall transferring from wheelchair to shower chair.
Record review of the documentation revealed R#1 received a bath on the following dates in September, October, November, December, and thru January 11, 2023: 9/2/2022, 9/16/2022, 9/23/2022, 9/26/2022, 10/12/2022, 10/17/2022, 10/21/2022,10/31/2022, 11/2/2022, 11/11/2022, 11/14/2022, 11/16/2022, 11/18/2022, 12/2/2022, 12/7/2022, 12/14/2022, 12/21/2022, 12/28/2022, 12/30/2022, 1/4/2023, 1/9/2023.
During Resident Council (RC) meeting on 1/11/2023 beginning at 10:00 a.m. R#1, R#14, and R#54 revealed they are scheduled for a bath three times a week but are lucky to get a shower one day a week. R#1 revealed that frequently the certified nursing assistant (CNA) wakes her up between 10:00 p.m. and 10:30 p.m. to get a shower while she is sleeping. If R#1 doesn’t want to get up, the aides state that R#1 refused.
R#54, the RC vice-president, was in attendance for the RC meeting and stated he has started washing in the bathroom sink to avoid fooling with the staff.
Review of the shower record notebook revealed that baths are scheduled one week Monday, Wednesday, Friday, or Tuesday, Thursday, and Saturday, divided between different shifts. There were three completed bath sheets for October, four bath sheets for November, approximately ten bath sheets completed for December, and one bath sheet completed for January 4, 2023. Further review revealed that at least half the bath sheets had refused documented.
Review of the Grievance reports revealed complaints about not getting showers on scheduled days. Staff was in-serviced on following bathing schedules.
Interview on 1/12/23 at 1:30 p.m. with the Director of Nursing (DON) revealed that she found some bath sheets but was unable to locate the rest of the bath sheets. The DON further revealed bath sheets are to be completed by the CNA with any skin changes or refusal, signed, and given to the nurse. If the resident refused, the nurse should document the refusal in the clinical record. If showers are missed, they should be offered the next shift or the next day. The DON’s expectation is that residents are getting all their care and needs met and bathed three times a week.
Interview on 1/12/23 at 1:33 p.m. with CNA BB revealed that when she is unable to provide a shower on the resident’s scheduled day, she tries to complete the showers on the next day that she works.
Interview on 1/12/23 at 2:20 p.m. with the Administrator revealed her expectation was that residents are clean, get their baths as scheduled, and whenever they request one.
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