The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.
§483.10(f)(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, and plan of care and other applicable provisions of this part.
§483.10(f)(2) The resident has a right to make choices about aspects of his or her life in the facility that are significant to the resident.
§483.10(f)(3) The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility.
§483.10(f)(8) The resident has a right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility.
Based on clinical record reviews and staff interview, it was determined that the facility failed to accommodate residents' preferences regarding showers for one of 13 residents reviewed (Resident 4).
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 4, dated November 6, 2019, revealed that the resident was alert and dependent on staff for bathing. The resident's care plan, dated May 3, 2019, revealed that he required assistance with care tasks and preferred to have a shower.
Resident 4's shower records for September 2019 revealed that he received a bed bath instead of a scheduled shower on October 6, 13, 16 and 30 and November 6, 2019. A nursing note dated November 10, 2019, indicated that the resident "demanded to have a shower."
On the above dates, there was no documented evidence regarding why a bed bath was given instead of a shower, and no documented evidence that the resident refused a shower.
Interview with Nurse Aide 4 on November 26, 2019, at 12:20 p.m. revealed that she documented the bed baths on October 6, 13, 16 and 30, and November 6, 2019, as "late entries" on November 26, 2019, and she did not recall if the resident refused any showers.
Interview with the Director of Nursing on November 26, 2019, at 12:30 p.m. revealed that she was unaware that the above documented bed baths were "late entries" completed on November 26, 2019, and that there were no documented reasons regarding why showers were not provided as scheduled for Resident 4.
28 Pa. Code 201.29(j) Resident rights.
Previously cited 10/8/19.
28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 10/8/19.
| ||Plan of Correction - To be completed: 01/08/2020|
The facility will ensure that residents' preferences regarding showers are accommodate including resident 4. Facility staff interviews resident to obtain shower preference. Once obtained they are added to the shower schedule and it is part of the Certified Nursing Assistant assignment sheet that is disctributed daily. Showers completed and/or refused are documented using Point of Care electronic health record system.
The Director of Nursing or Designee will re-educate nursing staff including new hires and agency staff on the facility policy and procedure for accommodating residents' preferences regarding showers.
The Director of Nursing or Designee will perform an audit 2 times a week for 2 weeks , and weekly for 2 weeks , then monthly for 3 months to ensure residents' preferences for showers are being accommodated. The results of these audits will be reported to the monthly Quality Assurance and Performance Improvement Committee for review and frequency of audits.