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Based on record review, observation and interview, the Nursing staff failed to ensure personal hygiene care was performed for 3 of 10 sampled patients (Patients' #2, #6 and #7).
The findings include:
Review on 11/15/2016 of the facility's policy "Nurse Aide Standard Work Expectations for each shift" revealed "...Provide daily bath for your patients. Communicate with off-going shift regarding bathing needs/plans ..."
1. Review on 11/14/2016 of Patient #2's closed record revealed a 68 year old woman who had back to back visits to the ED (emergency department) for "altered mental status." Diagnoses included depression, manic state and Parkinson's disease. Patient #2 was held in the ED from 10/13/2016 through 10/15/2016 and released home after a second psychologic evaluation. The patient returned the next day and was held in the ED following psychologic evaluation. On 10/19/2016, after 2 incontinent episodes and because the CT scan of the head from the first ED visit had showed some "mild chronic vascular changes," Patient #2 was admitted to the Medical Surgical unit, for a neurological workup, under observational status on 10/19/2016 and was changed to inpatient status on 10/22/2016. The patient was discharged to a Skilled Nursing Facility on 11/01/2016.
Review of the personal hygiene section of Patient #2's medical record, while on the Medical Surgical floor between 10/19/2016 and 11/01/2016, revealed a bath was documented each day with the exception of the following: On 10/19/2016, documentation revealed the patient received oral care, peri care and skin care, but no documentation of a bath; On 10/21/2016 no documentation of a bath or any personal hygiene care documented; On 10/22/2016, there was documentation staff cleaned the patient's face and applied moisturizer, but no documentation of a bath, nor any additional personal hygiene care; On 10/28/2016, there was no documentation under the "personal hygiene" section of the patient's record; On 10/29/2016, documentation revealed the patient "would not allow caregiver to give any care." Review revealed the patient did not receive a bath 5 of the 14 days the patient spent on the floor. One of the 5 days it was documented the patient "refused" personal hygiene care, with no documentation of re-approaching the patient at a later time.
Observation on 11/14 between 1100 and 1230 during the initial tour of the Medical Surgical Unit and during interviews with 4 patients, revealed patients appeared clean and groomed. CNA's were going from room to room giving baths and helping with personal hygiene.
Interview on 11/14/2016 between 1118 and 1133 with Patient' #4, #5 and #6, revealed they were happy with their care and had no complaints with the personal hygiene they received.
The interview on 11/14/2016 at 1133 with patient #6, revealed "I like to do my own bathing ..." The interview revealed when the staff did bathe her, she had no concerns.
Interview on 11/14/2016 at 1150 with Patient #7, revealed "My hair hasn't been washed since I've been here that I know of..."
Interview on 11/15/2016 with CNA #1, revealed "Patients are bathed every day unless they refuse... If their hair is dirty, we offer a no rinse shampoo..."The CNA stated "The only time gel gets in hair is after an EEG and we do try to get that out."
Interview on 11/15/2016 at 1630 with the Vice-President of Nursing Operations, revealed "The expectation is patients get offered a bath every day and PRN (as needed)... Documentation in regards to that (bathing) is policy."
2. Review on 10/16/2016 of Patient #6's open medical record revealed a 72 year old female who presented to the ED on 11/08/2016, status post total hip replacement on 10/31/2016, with swelling of the Right leg, shortness of breath and 2 days of incontinence. The patient was admitted to the Medical Surgical Unit on 11/08/2016 and was discharged home on 11/16/2016.
Review of the personal hygiene section of the patient's medical record during her stay on the Medical Surgical floor from 11/08/2016 through 11/16/2016, revealed documentation on 11/08/2016 of peri care and "moderate assistance elimination assistance," but no documentation of a bath; On 11/10/2016, it was documented the patient "refused" a bath; On 11/11/2016, there was no documentation of any personal hygiene care; and on 11/14/2016 and 11/15/2016, documentation revealed the patient "refused" a bath both days. Review revealed the patient did not receive a bath 5 of 9 days. 3 of the 5 days it was documented the patient "refused" personal hygiene care. There was no documentation of re-approaching the patient at a later time to perform personal hygiene care on the days the patient refused.
Observation on 11/14 between 1100 and 1230 during the initial tour of the Medical Surgical Unit and during interviews with 4 patients, revealed patients appeared clean and groomed. CNA's were going from room to room giving baths and helping with personal hygiene.
Interview on 11/14/2016 between 1118 and 1133 with Patient' #4, #5 and #6, revealed they were happy with their care and had no complaints with the personal hygiene they received.
The interview on 11/14/2016 at 1133 with patient #6, revealed "I like to do my own bathing ..." The interview revealed when the staff did bathe her, she had no concerns.
Interview on 11/14/2016 at 1150 with Patient #7, revealed "My hair hasn't been washed since I've been here that I know of..."
Interview on 11/15/2016 with CNA #1, revealed "Patients are bathed every day unless they refuse... If their hair is dirty, we offer a no rinse shampoo..." The CNA stated "The only time gel gets in hair is after an EEG and we do try to get that out."
Interview on 11/15/2016 at 1630 with the Vice-President of Nursing Operations, revealed "The expectation is patients get offered a bath every day and PRN (as needed)... Documentation in regards to that (bathing) is policy."
3. Review on 10/16/2016 of Patient #7's open medical record revealed a 76 year old female admitted on 10/29/2016 after presenting to the ED with "generalized weakness." The patient underwent a right colectomy and partial ileal resection on 11/03/2016 and remained a current patient at the time of the survey.
Review of the personal hygiene section of the patient's medical record during her stay on the Medical Surgical floor from 10/29/2016 through present, revealed the following: On 10/30/2016 documentation revealed the patient "refused personal hygiene;" On 10/31/2016, 11/01/2016, 11/02/2016, and 11/11/2016, there was no documentation of any personal hygiene having been performed; On 11/13/2016, "skin care" was performed, but not documentation of a bath or personal hygiene.
Observation on 11/14 between 1100 and 1230 during the initial tour of the Medical Surgical Unit and during interviews with 4 patients, revealed patients appeared clean and groomed. CNA's were going from room to room giving baths and helping with personal hygiene.
Interview on 11/14/2016 between 1118 and 1133 with Patient' #4, #5 and #6, revealed they were happy with their care and had no complaints with the personal hygiene they received.
The interview on 11/14/2016 at 1133 with patient #6, revealed "I like to do my own bathing ..." The interview revealed when the staff did bathe her, she had no concerns.
Interview on 11/14/2016 at 1150 with Patient #7, revealed "My hair hasn't been washed since I've been here that I know of..."
Interview on 11/15/2016 with CNA #1, revealed "Patients are bathed every day unless they refuse... If their hair is dirty, we offer a no rinse shampoo..."The CNA stated "The only time gel gets in hair is after an EEG and we do try to get that out."
Interview on 11/15/2016 at 1630 with the Vice-President of Nursing Operations, revealed "The expectation is patients get offered a bath every day and PRN (as needed)... Documentation in regards to that (bathing) is policy."
NC00122239