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Based on interview and record review, the facility failed to update the nursing care plan for 1 (#10) of 12 patients reviewed, resulting in the potential for less than optimal outcomes. Findings include:

On 6/4/19 at approximately 0900, medical record review revealed the patient of concern was a 76-year-old female who admitted to the hospital with a pelvic fracture (after a fall at home) on 4/18/19 through 4/23/19. The patient had other comorbidities including left wrist fracture in cast, herniated vertebral lumbar/sacral (back) disk, uncontrolled hypertension, insulin dependent diabetes mellitus, history of asthma, history of transplant, osteoporosis. Review of the patient care flow sheets for baths revealed that the patient did not have a complete bath documented on 4/19/19, 4/21/19, and 4/22/19 (length of stay was five days). 'Nursing Progress Notes, dated 4/22/19 at 10:40 PM' document the patient refusal only for 4/22/19. The Nursing Care Plan provided for the hospitalization documented "Problem: Self Care (goal: improve) -- Interventions: 1. Assess ability to perform activities of daily living." No specific interventions were listed after the assessment. The plan was not individualized as to how much self care the patient could perform and/or when she preferred to do self care or complete bath.

Review of the medical record with the Director of Nursing A (DON), on 6/4/19 at 1230 - 1330, revealed no other documentation as to why the patient hadn't received a bath the other two days, stating baths are given daily or according to patient preference. Further nursing documentation was reviewed with the DON and no documentation regarding bath preferences or update to the patient's Nursing Care Plan regarding baths was documented. No policy was provided on patient baths. On 6/4/19 at approximately 1100, both Accreditation Manager N and Corporate Regulatory Manager P stated that there was "no bath policy." On 6/4/19 at approximately 1330, the DON verified that a daily bath was expected to be given or was to be given according to patient preferences. The patient self care or bath preference was not documented or updated in the nursing care plan.

On 6/4/19 at 1400, review of the facility policy titled "Adult Assessment and Reassessment Guidelines, Policy Number 401 Appendix A, revised 2/14/14," documented, "Care Plan -- Review daily; Update PRN (as needed) change in condition/diagnosis; evaluate progress toward goals daily and prior to discharge." This had not been done.