The resident, identified as Resident #3 in the November inspection report, told state investigators during a bedside interview: "I did not always get showers when I should."
Inspectors found the resident in bed without a shirt, wearing only an adult brief with the sheet pulled off their body during an October observation. The resident had been admitted with cerebrovascular disease, speech difficulties, and asthma, but retained full cognitive abilities according to assessment records.
The facility's own care plan, dated January 20, documented interventions to provide showers twice per week "as per the resident's preference." Nursing instructions specified Tuesday and Friday evening showers starting January 24.
But accountability records painted a different picture. In July, certified nurse aide documentation showed the resident received only five showers out of nine scheduled for the 3 PM to 11 PM shift. August was worse — just three showers total for the month.
The resident had made bathing preferences clear from admission. Assessment records noted it was "very important" for the resident to choose between different bathing options. The comprehensive care plan acknowledged this dependency, documenting that the resident required complete staff assistance for bathing and transfers.
When confronted with the pattern, a Staff Development Licensed Practical Nurse told inspectors the resident "usually told the staff when they wanted their shower" and "did not refuse their showers." The explanation contradicted the documented care plan requiring scheduled twice-weekly assistance.
Certified Nurse Aide #2 acknowledged the problem during interviews, stating "there was a time when the resident reported they did not receive a shower on the 3 PM-11 PM shift."
The facility's Director of Nursing admitted to systemic documentation failures. They told inspectors they had "observed a pattern on the 3-11 and 11-7 shifts in which the Certified Nurse Aides were not documenting the care provided."
The nursing director said supervisors should review electronic documentation systems to confirm care was actually completed, but the accountability records suggested this oversight wasn't happening consistently.
Renaissance Rehabilitation's own policies, revised in September 2024, emphasized creating an individualized environment for each resident's quality of life. The policies required staff "across all shifts and departments" to understand and support quality of life principles and "honor each resident's preferences, choices, values, and beliefs."
The facility also committed to ensuring residents received "appropriate treatment and services to maintain or improve their ability to perform activities of daily living."
For Resident #3, those commitments weren't met. The resident who valued having bathing choices and required complete assistance received inconsistent care that fell far short of their documented preferences and care plan requirements.
The inspection revealed broader systemic issues beyond this single resident's experience. The Director of Nursing's acknowledgment of documentation patterns across multiple shifts suggested the problem extended beyond individual aide performance to supervisory oversight and quality assurance systems.
State inspectors classified the violation as causing "minimal harm or potential for actual harm," but the human impact was clear in the resident's own words about missing scheduled care.
The facility's failure affected what inspectors termed "few" residents, though the inspection focused specifically on activities of daily living for just three residents total. How many other residents experienced similar gaps in basic hygiene assistance remains unclear from the available records.
Renaissance Rehabilitation must now develop corrective actions to address both the immediate bathing care failures and the underlying documentation and oversight problems that allowed consistent care gaps to continue for months.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Renaissance Rehabilitation and Nursing Care Center from 2025-11-19 including all violations, facility responses, and corrective action plans.
Additional Resources
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