Failure to Provide Toileting Hygiene for Dependent Resident
Penalty
Summary
The facility failed to provide toileting hygiene care after a bowel movement for a resident who was dependent on staff for all activities of daily living, including toileting hygiene. The resident had a history of acute respiratory failure, a Stage 3 pressure ulcer on the right buttock, and neuromuscular dysfunction of the bladder, and was assessed as having moderate cognitive impairment and requiring maximal to total assistance for personal care. Emergency personnel reported that the resident was found with soiled incontinence briefs and had not been changed or showered in some time when transported from the facility. Interviews with staff and review of documentation revealed inconsistencies and lack of clarity in how toileting hygiene was recorded. The CNA task flowsheet did not have a specific section to document whether toileting hygiene was provided after a bowel movement, and staff relied on assumptions that care was given if a bowel movement was recorded. Documentation showed a gap between the last recorded bowel movement and the last documented toileting hygiene, with no clear evidence that hygiene care was provided after the resident's last bowel movement. The facility's policy required assistance with activities of daily living for residents unable to perform them, but this was not consistently documented or verified in practice.