Failure to Provide Bowel and Bladder Retraining and Toileting Programs
Penalty
Summary
The facility failed to provide appropriate bowel and bladder retraining and/or toileting programs for two residents, resulting in a deficiency related to continence care. Both residents were assessed as being able to express their needs and request assistance for toileting, yet neither was placed on a structured program to help restore or maintain normal bowel and bladder function. Instead, care plans and staff practices defaulted to providing incontinence care, such as the use of adult diapers, without individualized interventions aimed at promoting continence. For one resident, records indicated a history of mild protein-calorie malnutrition, muscle wasting, and dependence on staff for transfers and toileting. Despite being able to communicate needs and use a urinal, the resident was not included in a bowel and bladder program. Staff interviews confirmed that the resident could feel the urge to urinate or defecate but often lost control due to delays in assistance, and there was no explanation for the absence of a retraining program. The second resident had diagnoses including chronic cystitis, urinary tract infection, and diverticulosis, and was documented as always incontinent in both bowel and bladder. However, interviews and assessments revealed that the resident was aware of toileting needs and could call for assistance, but was routinely provided with diapers and not assisted to the bathroom. Staff acknowledged the lack of a bowel and bladder management program and recognized the need for better assessment and documentation. Facility policies reviewed indicated that services should be provided to restore or improve continence, but these were not implemented for the residents in question.