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F0550
D

Failure to Maintain Resident Dignity by Not Emptying Bedside Commode

Mount Pleasant, Iowa Survey Completed on 08-25-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Staff interviews, record review, and facility policy revealed that the facility failed to maintain resident dignity by not emptying a bedside commode after providing toileting assistance for a resident who was dependent on staff for transfers and toileting hygiene. The resident, who had intact cognition and required a mechanical lift with two staff for transfers due to chronic obstructive pulmonary disease (COPD) and fall risk, was found to have her bedside commode left unemptied on multiple occasions. Several CNAs reported noticing the commode containing urine and feces when starting their shifts, with some stating they had informed nurses about the issue, while others did not report it due to previous inaction. The resident was aware of the situation and commented on it to staff. The Director of Nursing (DON) and Administrator were unaware of the issue, as staff had not consistently reported it to them. The facility's policy requires that residents be treated with respect and dignity, and that the environment should promote quality of life. Despite this, the commode was not promptly emptied and cleaned after use, as expected by facility policy and as stated by the DON. The failure to empty the commode after use was confirmed by multiple staff members and was not addressed in a timely manner, resulting in a lack of dignified care for the resident.

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