§483.24(a)(2) A resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene;
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Observations:
Based on review of facility policies, clinical records, and shower schedules, as well as staff interviews, it was determined that the facility failed to ensure that residents were provided with showers and/or showers as scheduled for three of eight residents reviewed (Residents 1, 2, 6).
Findings include:
The facility's policy regarding bath/showering, dated October 31, 2023, indicated that residents will be bathed or showered according to their preferences to maintain healthy hygiene and skin condition. Each resident will be scheduled to receive bathing a minimum of two times per week unless they prefer less frequent baths or state regulations requires more frequent bathing. The facility will develop and maintain a bathing/shower schedule for each unit. When the bath or shower is complete, the nursing assistant will document the activity on the shower sheet or in the electronic medical record. If the bath/shower cannot be given or if the resident refuses, the nursing assistant will promptly report this to the charge nurse. The charge nurse will speak with the resident who refuses to ascertain why they are refusing and to determine if alternative arrangements that suit the resident can be made. If the resident continues to refuse, the charge nurse will document the resident's refusal in the medical record.
An admission Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated January 24, 2024, revealed that the resident was understood, could understand, was cognitively impaired, required substantial assistance with bathing, and indicated that it was somewhat important to choose his bathing.
The facility's shower schedule revealed that Resident 1 was to receive showers on Thursday during the daylight shift (6:00 a.m. to 2:00 p.m.).
Resident 1's bathing records for January and February 2024 revealed no documented evidence that the resident received a shower as scheduled on Thursday, January 25, 2024, and there was no documented evidence that the resident was offered and/or refused any showers.
An admission MDS assessment for Resident 2, dated January 4, 2024, revealed that the resident was understood, could understand, and had a diagnosis of Cerebral Vascular Accident (CVA - commonly known as a stroke).
The facility's shower schedule revealed that Resident 2 was to receive showers on Wednesday during the daylight shift (6:00 a.m. to 2:00 p.m.).
Resident 2's bathing records for January and February 2024 revealed no documented evidence that the resident received a shower as scheduled on Wednesday, January 31, 2024, and February 7, 14, and 21, 2024, and there was no documented evidence that the resident was offered and/or refused any showers.
A quarterly MDS assessment for Resident 6, dated January 23, 2024, revealed that the resident was understood, could understand, and had a diagnosis of Parkinson's disease.
The facility's shower schedule revealed that Resident 6 was to receive showers on Tuesday during the daylight shift.
Resident 6's bathing records for January and February 2024 revealed no documented evidence that the resident received a shower as scheduled on Tuesday, January 30, 2024, and February 6, and 20, 2024, and there was no documented evidence that the resident was offered and/or refused any showers.
Interview with the Director of Nursing on February 21, 2024, at 3:59 p.m. confirmed that there was no documented evidence that Residents 1, 2 and 6 received or were offered and refused showers as scheduled on the above dates.
28 Pa. Code 201.14(a) Responsibility of Licensee.
28 Pa. Code 211.12(d)(5) Nursing Services.
| | Plan of Correction - To be completed: 03/18/2024
1. Resident 1 was offered a shower per their shower preferences, but the resident refused the shower. Documentation was entered in his record to reflect such. Resident 2 was offered a shower and did receive a shower on 2.21.24 and documentation was entered in his record to reflect such. Resident 6 was offered a shower on 2.21.24 and he refused. Documentation was entered in his record to reflect such.
2. To identify other residents that have the potential to be affected, each resident was queried as to what their shower preferences are and a new shower schedule has been created per those preferences and is being utilized to provide resident showers.
3. To prevent recurrence of the deficient practice, C.N.A.s, LPNs and RNs to be educated by the Director of Nursing or designee on the process of providing resident showers per resident preferences and the process of documenting resident showers in the electronic medical record. Resident shower preferences are obtained upon admission.
4. To maintain and monitor compliance, an audit of residents' showers will be completed by the Director of Nursing or designee five times per week for two weeks and then weekly for two weeks to determine if resident showers have been provided according to resident preferences.
5. Audits will be forwarded to the Quality Assurance and Process Improvement committee for review and recommendations.
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