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Based on medical record reviews, staff interviews, review of medical floor staffing, review of facility policies, and review of employee files, the facility failed to ensure that patients were bathed or offered a bath daily.

Findings include:

Review of ten (10) medical records revealed:
#1, admitted on 9/27/2016: received two (2) baths on 9/28/1016, and a bath on 10/2/2016. The patient was discharged on 10/2/2016.
#2, admitted on 9/29/2016: a bath was provided on 10/4/2016, patient had showered on 10/5/2016 and 10/6/2016; discharged 10/6/2016
#3, admitted on 9/29/2016; showered on 10/2/2016; refused a shower on 10/3/2016; showered on 10/4/2016; refused a shower on 10/7/2016; discharged on 10/7/2016
#4, admitted on 10/1/2016: refused a bath on 10/2/2016; self bathed on 10/4/2016 and 10/5/2016; discharged on 10/5/2016
#5, an inpatient, admitted on 2/22/2017; received two (2) baths on 2/23/1017; a bath on 2/24/2017 and 2/28/2017 (as of 2/28/2017)
#6, an inpatient, admitted on 2/26/2017; received a bath on 2/27/2017 (as of 2/28/2017)
#7, an inpatient, admitted on 2/15/2017; received a bath on 2/18/2017, 2/19/2017, 2/20/2017 and 2/24/2017 (as of 2/28/2017)
#8, admitted on 2/26/2017; received a bath 2/27/2017; was discharged on 2/28/2017
#9, an inpatient, admitted on 2/26/2017; refused a bath on 2/26/2017, received a bath on 2/28/2017 (as of 2/28/2017)
#10, an inpatient, admitted on 2/26/2017; showered on 2/28/2017 (as of 2/28/2017)

Interview with the 8 South Manager on 2/28/2017 at 10:10 AM on the unit revealed that the expectation is that patients would receive a "bath" using warmed sage wipes (or a washcloth if patient prefers) daily, and that the hospital did not use wash basins any longer. He/she continued on explaining that due to use of wipes, sometimes the patient did not understand that it was actually a bath, sometimes they refused a bath, and sometimes they preferred a family member to provide bathing. The manager also stated that shower chairs were provided to patients who could shower independently, those whose family member chose to assist them in the shower, or for those who required staff assistance (as available to do so).
The manager stated that he/she received complaints regarding not having received a bath about four (4) times per month.

Review of staffing matrix and actual staffing for 4 North, 7 North and 8 South for a two (2) week period (9/18-9/24/2016 and 10/2-10/8/2016) revealed that staffing was adequate in all areas on all shifts.

Review of facility policy 500-00, Plan for the Provision of Patient Care, original date 11/1994, last revised 09/2015, revealed that it is the policy of Gwinnett Hospital System to provide a patient care delivery system that is based in its mission, vision, and values.
A. Provision of Care
Gwinnett Medical Center (GMC) in Lawrenceville, GA is an acute-care facility with 353 licensed beds. GMC provides a comprehensive range of services for patients that includes primary care and specialty clinics, inpatient medical acute care, inpatient and outpatient obstetric care, pediatrics, neonatal intensive care, inpatient and outpatient surgery, emergency care, and trauma care.
The GHS has the capacity to treat any patient condition with the exception of conditions such as major burns, transplantation, specialized pediatrics, and mental health. GHS works in conjunction with the appropriate receiving speciality facility to coordinate care as needed, up to and including transfer.
E. Training, Development and Education
Associates are introduced to the organization, department and specific job responsibilities through a formal orientation process. Orientation for all associates includes information on; at minimum:
- Mission, vision, values
- Standards of performance
- Environment of care (safety and security)
- Infection control
- Corporate compliance and ethics
- Diversity
- Patient safety
Clinical staff receive initial training.
All associates are oriented to job specific policies and procedures, equipment, and job-related aspects of patient safety.
Ongoing inservice education and other training are offered to associates to increase his or her knowledge of work related issues. Programs may be offered based on feedback from associates, educational program evaluations, annual associate performance evaluations, performance improvement initiatives, patient safety initiatives, patient satisfaction survey results, age specific competencies required by job description, policy changes, and implementation of new equipment, technology, techniques or work processes.
Leadership uses a combination of job descriptions, skills checklists, performance measures and 360 degree performance evaluations to evaluate job performance, current competencies and skills. Staff competence is maintained through a combination of ongoing competence assessment and educational activities.

Review of six (6) employee files revealed that all contained initial applications with references, job descriptions, had received annual trainings which included infection control, and isolation, had underwent competency testing and evaluations; and, had current BLS training as appropriate.