Failure to Provide Timely Oral and Incontinence Care for Dependent Residents
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADL) for several residents who were dependent on staff for care, specifically in the areas of oral hygiene and timely incontinence care. Observations revealed that two residents had visible accumulations of brown sediments on their teeth, indicating a lack of oral care. One of these residents was unable to communicate due to cognitive impairment, while the other, who was cognitively intact, reported that staff had not assisted with mouth care for an extended period. Both residents had care plans indicating the need for staff assistance with oral hygiene due to self-care deficits related to their medical conditions. In addition, two other residents who were paraplegic and always incontinent reported and were observed to experience delays in receiving incontinence care. One resident stated that incontinence care was typically provided only twice daily, resulting in prolonged periods spent in wet undergarments while seated in a wheelchair. Another resident was found in bed with a strong odor of urine and feces, having activated the call light for assistance approximately five minutes prior to being attended to. This resident reported that wait times for incontinence care could exceed one hour, and staff interviews confirmed that care was not consistently provided every two hours as required by facility policy. The affected residents had significant medical histories, including hemiplegia, paraplegia, neuromuscular dysfunction of the bladder, and other conditions resulting in self-care deficits. Facility policies and job descriptions for CNAs, LPNs, and the DON outlined the expectation for regular oral care and incontinence care every two hours or as needed, but these standards were not met for the residents reviewed. The deficiencies were identified through direct observation, resident interviews, record reviews, and staff interviews.