Failure to Provide Timely Incontinent Care and Assistance with ADLs
Penalty
Summary
A deficiency occurred when a resident with a history of overactive bladder, urinary incontinence, muscle weakness, unsteadiness, and difficulty walking did not receive necessary assistance with activities of daily living, specifically grooming and personal hygiene. The resident, who was moderately cognitively impaired and required substantial to maximum assistance with toileting, was observed to be wet from an incontinent episode during the morning hours. Staff interviews revealed that the certified nursing assistant (CNA) responsible for the resident had last checked on her between 6:00 a.m. and 6:15 a.m., but did not check if the resident was wet during subsequent rounds. Another nursing assistant also did not check on the resident, assuming she was able to use the bathroom independently. The resident reported frequently waiting to be changed and noted that it was unusual to have breakfast without being wet. Observations confirmed the resident's nightgown was wet up to the middle of her back. The Director of Nursing (DON) stated that staff are expected to check residents for incontinent episodes, even if they are only occasionally incontinent, to prevent skin breakdown, ensure comfort, and prevent infection. The facility did not have a specific policy regarding incontinent care, but their skin integrity management guidelines indicated that skin should be cleansed at the time of soiling and at routine intervals.