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Based on interviews and record reviews, the facility failed to ensure nursing care was provided in accordance with acceptable standards of care. Specifically, the facility failed to ensure oral hygiene and bathing needs of patients were addressed in 5 out of 10 records reviewed (Patients #1, #5, #6, #8 and #10).

The failure resulted in the patient's physical needs not being addressed.

FINDINGS

REFERENCE

According to the facility's Plan for the Provision of Patient Care, Treatment, and Services, the fundamental standards of patient care include the physical needs of the patient are attended to through interventions to achieve an optimal health outcome.

1. The facility failed to ensure patients received oral care daily.

a) Patient #1 had three admissions to the facility over 6 months for rehabilitation therapy due to partial paralysis. According to the medical record Patient #1 required assistance for eating, bathing and transfers. Review of the Patient #1's medical record revealed a lack of documentation to show oral care had been provided or offered and refused. From 3/30/16 thru 5/06/16 there was documentation to show Patient #1 received oral care 7 times in 67 days during the first admission period. During a second admission, 6/03/16 thru 7/06/16, documentation within the medical record showed Patient #1 received oral care 8 times in 33 days. During Patient #1's final admission, 7/08/16 thru 9/29/16, documentation in the medical record showed oral care was performed 21 times in 81 days.

b) Review of the medical record for Patient #8 revealed s/he had been admitted from 12/24/15 thru 5/18/16 for post-operative wound care of a decubitus ulcer and was under special protocol which required Patient #8 to lay flat on bedrest for up to 4 weeks making the patient dependent for all care. A focused review was performed for the period 5/01/16 to 5/18/16. The record showed documentation of oral care 2 out of 18 days.

c) Patient #10 was admitted 11/12/16 thru 11/15/16 for rehabilitation due to spinal compression resulting in weakness to the lower extremities and left arm. According to an occupational therapy note, dated 11/14/16, the patient required assistance to sit at the edge of the bed and assistance with oral care. Further review of the medical record showed the patient received oral care only once during occupational therapy. There was no documentation to show oral care was provided or offered by nursing staff.

d) On 11/15/16 at 10:47 a.m. an interview was conducted with the Education Coordinator (Registered Nurse #3). RN #3 reviewed the process for documentation of care provided with in the medical. For hygiene care, RN #3 stated the nursing staff checked off the care provided in the reassessment section of the medical record. According to RN #3, if the care was not checked off as completed then it wasn't done.

During a second interview with RN #3, on 11/17/16 at 1:57 p.m., s/he identified the 2 means to verify patient care was provided in addition to documentation was to look at the patient and speak to the Certified Nurse's Aides (CNAs). According to RN #3, CNAs received instruction on hygiene care expectations during orientation and stated it was basic fundamental care. S/he also stated there was no formal audit performed to verify all hygiene care was performed as documented. RN #3 confirmed administrative leadership performed rounds daily to speak with patients regarding their care but the performance of oral care and bathing were not questions directed to the patients though they would be in the future as a result of the survey. RN #3 stated there was no single document which addressed hygiene care but the provision of daily bathing and oral care to patients was an expectation of the facility.

e) An interview was conducted with a Nursing Supervisor (RN #2) on 11/16/16 at 4:14 p.m. According to RN #2 oral care was to be completed on every patient every day and must be documented in the medical record. If the patient refused or the care was not completed there should be documentation to show it was refused or why it was not performed. RN #2 further stated patients unable to sit up due to restrictions were to receive the same daily oral care from the nursing staff. S/he further stated CNAs were trained to document in the medical record and if it was not documented in the medical record it was not done.

2. The facility failed to ensure documentation showed daily baths were provided to patients.

a) During review of the medical record of Patient #1 documentation revealed throughout 3 admissions in 6 months, bathing was not performed as expected by the facility. Patient #1 was admitted 3/30/16 thru 5/06/16 for rehabilitation related to post-operative wound care and a history of partial paralysis which required flat bed rest for up to 4 weeks. According to documentation in the medical record Patient #1 received baths 10 times in 67 days. Patient #1 had a subsequent admission 6/03/16 thru 7/08/16 which showed baths were provided 8 times during the 33-day admission. From 7/09/16 thru 9/29/16 Patient #1's last admission showed documentation of bathing 33 times in 81 days.

b) Patient #6 was admitted 6/21/16 thru 7/14/16 for respiratory failure with a tracheotomy in place. Review of the medical record revealed s/he received baths 6 times in the 31-day admission.

c) On 11/07/16 Patient #5 was admitted with respiratory failure to be weaned from a ventilator. Review of the medical record revealed no documentation to show bathing was performed on 11/12/16 and 11/13/16 as expected by the facility.

d) Patient #8 was admitted 12/24/15 thru 5/18/16 for post-operative wound care of a decubitus ulcer. Review of the medical record for a period of 18 days (5/01/16-5/18/16) showed documentation of baths for only 3 days during that timeframe.

e) On 11/17/16 at 2:36 p.m. an interview was conducted with the Chief Clinical Officer (Administrator #4). According to Administrator #4 the expectation of the facility was for every patient to receive a bath and oral care at least daily. Administrator #4 further stated it was important hygiene care be provided to the rehabilitation patient because they could not do it themselves. S/he verbalized surprise at the lack of documentation of care performed and stated patients looked clean and s/he witnessed the shower room in use daily. Administrator #4 confirmed leadership rounds were performed daily to obtain feedback from each patient or family member regarding the care provided and to address unmet needs. Administrator #4 stated the visualization of patients and medical record documentation was the means used to verify care was provided as expected.

f) An interview was conducted with a Certified Nurse's Aide (CNA #1) on 11/17/16 at 11:53 a.m. CNA #1 confirmed the duties of a CNA were to perform daily oral care, bathing and repositioning of patients then document the care in the medical record after it was performed, or if not performed to document the reason why and inform the primary nurse. CNA #1 stated bathing and oral care was necessary for the health of the patient and further stated it was the human thing to do.