Failure to Implement Bowel and Bladder Continence Program
Penalty
Summary
The facility failed to provide appropriate treatment and services to restore continence of bowel and bladder for one resident with multiple diagnoses, including cerebral palsy, epilepsy, congestive heart failure, muscle weakness, and diabetes mellitus. The resident was always incontinent of bowel and bladder, had moderate cognitive impairment, and was dependent on staff and a mechanical lift for transfers. Despite facility policies requiring assessment and implementation of interventions to restore continence, the resident's care plan only included general interventions such as assistance with toileting and peri-care as needed, and reminders to call for assistance. There was no evidence of a toileting, timed, or scheduled voiding program being implemented. Medical record reviews showed that the resident was identified as a candidate for toileting, timed, or scheduled voiding based on two separate evaluations, and the urinary incontinence tool indicated the resident could comprehend instructions and participate in such a program. However, documentation for a 30-day period confirmed the resident remained incontinent 100% of the time, and interviews with staff, including an LPN, CNA, and the DON, confirmed that no toileting program had been initiated. The DON acknowledged that the resident should have been placed on a toileting program according to the assessment tools used.