Failure to Provide Timely Repositioning and Incontinent Care
Penalty
Summary
A deficiency occurred when a male resident with a history of intracranial injury, spastic hemiplegia, contracture of the left hand, and moderate cognitive impairment was not provided with necessary assistance for activities of daily living, specifically repositioning and incontinent care. The resident was assessed as dependent on staff for transferring, bed mobility, and toileting, and was incontinent of bowel and bladder. His care plan included interventions for skin integrity, incontinence, and the need for regular repositioning and perineal care. On the day in question, the resident was observed in a Geri-chair from early morning until late afternoon, remaining in the same soiled clothing for several hours. Staff interviews revealed that the resident was not repositioned or provided with incontinent care every two hours as required. When finally assisted into bed, the resident was found to have a saturated brief with both urine and feces, and his skin showed slight redness. The CNAs and LVN assigned to his care admitted that rounds and care were not performed as scheduled, and that refusals of care were not reported to nursing staff as required by facility protocol. The facility's policy on incontinence care emphasized the importance of keeping skin clean and dry to prevent breakdown and infection, but did not specify the frequency of care. The Director of Nursing confirmed that it was expected for nurses and CNAs to make rounds and provide care every two hours, and that refusals should be reported and documented. However, on this occasion, the required care and monitoring were not provided, resulting in the resident being left in soiled conditions for an extended period.