Failure to Provide and Document Indwelling Catheter Care
Penalty
Summary
A deficiency was identified when a resident with an indwelling catheter did not receive proper catheter care as outlined in their care plan. The resident, who had diagnoses including dysphagia, major depressive disorder, and type 2 diabetes mellitus, was dependent on staff for personal hygiene and bathing. The care plan required daily and as-needed catheter care, monitoring for signs and symptoms of infection, and skin irritation checks every shift. However, review of the Treatment Administration Record (TAR) showed no evidence that licensed staff provided or documented daily catheter care, infection monitoring, or skin assessments as required. Interviews with facility staff, including the MDS Coordinator and the Director of Nursing, confirmed that the required catheter care and monitoring were not documented or performed according to the resident's care plan. The facility's policy on urinary catheters emphasized the importance of such care to prevent complications, but staff failed to implement and record these interventions for the resident.