Failure to Provide Bowel/Bladder Retraining and Appropriate Toileting Services
Penalty
Summary
A resident with a history of peripheral vascular disease, hypertension, and atrial fibrillation was admitted to the facility and initially assessed as frequently incontinent of bowel and bladder, requiring extensive assistance for toileting. Over time, the resident's care documentation showed a progression to total dependence for toileting, with no transfers to the toilet occurring. Despite quarterly and admission assessments indicating the resident was a possible or likely candidate for bowel and bladder retraining, there was no documentation of any assessment or implementation of a bowel/bladder retraining program. The resident reported being able to use the toilet for bowel movements during therapy but was told to use briefs after being moved to a different floor, where staff stated there was no accessible bathroom. Staff interviews revealed inconsistencies and errors in the completion of bowel and bladder assessments, with some staff unaware of the resident's current abilities or not having spoken directly to the resident about toileting needs. The care plan directed staff to check and change the resident every two to three hours but did not address restorative or retraining interventions. Therapy discharge notes indicated the resident would benefit from restorative nursing services, but no further therapy or restorative services were provided. The lack of appropriate assessment and services to restore continence contributed to the deficiency identified in the report.