Failure to Provide Timely Incontinence Care During Meal Service
Penalty
Summary
The facility failed to provide timely incontinence care for two residents who were dependent on staff for toileting and personal hygiene. Both residents had care plans indicating total assistance was required for toileting due to mobility impairments and incontinence of bowel and bladder. Despite activating their call lights and directly requesting assistance from staff, both residents experienced significant delays in receiving incontinence care. For one resident, the call light was activated prior to lunch to request a change after a bowel movement. Although a staff member acknowledged the request and notified the appropriate personnel, the resident was not changed until over two hours later, after lunch had been served and meal trays were removed. During this period, the resident remained in soiled briefs, and staff interviews confirmed that incontinence care was not provided during meal service. The second resident also requested to be changed before being brought to the dining area for lunch. The request was acknowledged by staff, but the resident was taken to the dining room and left to eat lunch without being changed. The resident remained in soiled briefs for an extended period, with incontinence care not provided until more than two hours after the initial request. Staff interviews revealed a practice of not providing incontinence care during meal times, and both residents expressed discomfort and dissatisfaction with the delays.