Resident's Refusal of Care Not Honored by CNAs
Penalty
Summary
A deficiency occurred when a resident, who had intact cognition and required total assistance with bathing, bed mobility, and toileting, was awakened early in the morning by two Certified Nurse Aides (CNAs) to provide personal hygiene care. The resident refused care, expressing a desire to continue sleeping, but the CNAs proceeded to provide incontinence care despite the resident's refusal. The resident reported being upset by the interruption and felt mishandled during the care, subsequently informing their family representative of the incident. The facility's policies on abuse prevention and resident rights state that all residents have the right to be free from abuse, mistreatment, neglect, and to make choices about aspects of their life in the facility. Despite these policies, both CNAs involved acknowledged that the resident refused care and was visibly upset, but they continued with the care due to concerns about skin breakdown from incontinence. The CNAs did not alert a nurse or supervisor as required when a resident refuses care, nor did they document the refusal at the time of the incident. Interviews with facility staff and the resident's family representative revealed that the resident had previously complained about being handled roughly by one of the CNAs and had requested not to receive care from that aide. The Director of Nursing confirmed that staff are instructed not to provide care if a resident refuses and to report such refusals. However, the CNA in question was still assigned to the resident, and the care was provided against the resident's wishes, leading to the reported deficiency.