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Based on interviews and document review, the facility failed to ensure patients were provided activities of daily living (ADLs). Specifically, the facility failed to provide assistance required for hygiene care in two of three medical records reviewed. (Patients #3 and #4)

Findings include:

References:

According to a document provided by the facility titled Lippincott Procedures - Bed Bath, performing a bed bath not only cleans a patient's skin but also stimulates circulation, provides mild exercise, and promotes comfort. It also enables assessment of the condition of the patient's skin as well as joint mobility and muscle strength. Documentation associated with bed bath includes: Date and time of the bed bath, patient's tolerance of the bed bath, range of motion, self-care abilities, and any unusual findings. Document teaching provided to the patient and family (if applicable), their understanding of that teaching, and any need for follow-up teaching.

According to a document provided by the facility titled Lippincott Procedures - Tub Baths and Showers, tub baths and showers provide personal hygiene, stimulate circulation, and reduce tension for a patient. They also allow observation of the condition of a patient's skin and assessment of joint mobility and muscle strength. Documentation associated with tub baths and showers includes: Patient's skin condition, any discoloration or redness, patient's tolerance of the procedure, teaching provided to the patient and family (if applicable), their understanding of that teaching, and any follow-up teaching needed.

1. The facility failed to ensure patients received a bath or shower in accordance with the facility's expectations.

a. Patient #3's medical record was reviewed. According to the History and Physical (H&P) dated 3/10/24, Patient #3 had a history of polytrauma (multiple injuries that involve multiple organs or systems) from a motor vehicle accident (MVA) with resultant traumatic brain injury (TBI) (an injury that affects how the brain works), cervical spine (the first seven stacked bones of the spine) surgery, osteomyelitis (a serious infection of the bone), splenic laceration (a ruptured spleen), as well as essential hypertension (abnormally high blood pressure), who over the last month had persistent abdominal pain and hematochezia (rectal bleeding). Patient #3 was admitted to the facility on 3/10/24 with the diagnosis of colitis (inflammation of the inner lining of the colon) .

Patient #3's medical record revealed they were hospitalized for 33 days and showed no evidence of bed baths or showers provided on 3/24/24, 3/25/24, and 3/26/24. Also on 4/4/24, 4/5/24, 4/6/24, and 4/27/24, there were no bed bath or showers documented, or patient refusals of bed bath or showers on these days.

b. Patient #4's medical record was reviewed. According to the H&P dated 4/1/24, Patient #4 had a history of chronic kidney disease (CKD), kidney transplant in 2001, poorly controlled insulin (a hormone that lowers the level of glucose (a type of sugar) in the blood) dependent diabetic and hypertension (high blood pressure). On 4/1/24, Patient #4 was admitted to the facility with a diagnosis of suspected pyelonephritis (kidney infection) of the graft kidney.

Patient #4's medical record revealed they were hospitalized for four days and showed no evidence of bed baths or showers on 4/1/24, 4/2/24, 4/3/24 and 4/4/24. There were no refusals of bed bath or showers documented on these days. Patient #4 had a shower on 4/5/24, the day of discharge.

c. On 4/23/24 at 9:05 a.m., an interview was conducted with registered nurse (RN) #1. RN #1 stated patients were given hygiene supplies upon admission, which included a toothbrush, toothpaste, and other hygiene necessities. RN #1 stated bed bath or shower refusals were to be documented in the patient's medical record. RN #1 stated hygiene, including bed baths and showers were important because being clean made patients feel better and it was good for the patients to get up and move. RN #1 also stated hygiene was important because it made patients feel more involved in their care.

d. On 4/23/24 at 9:24 a.m., an interview was conducted with patient care assistant (PCA) #2. PCA #2 stated patients were asked daily if they wanted a bed bath or shower. PCA #2 stated if a patient refused a bed bath or shower, the nurse was to be notified and the refusal was expected to be documented. PCA #2 stated patient hygiene was important because there was an increased risk of bacteria being left on the skin which could cause an infection, which could result in sepsis (a serious condition in which the body responds improperly to an infection) if bathing was not completed.