Failure to Provide Appropriate Bowel and Bladder Care and Assessment
Penalty
Summary
Two residents did not receive appropriate treatment and services to restore or maintain bowel and bladder continence, as required by facility policy and regulatory standards. One resident experienced a significant decline in continence status without a comprehensive assessment or individualized toileting plan. Despite documentation in the care plan to conduct a three-day bladder diary and assessment on admission, quarterly, annually, and with significant change, there was no evidence that such assessments or a voiding pattern study were completed after the resident's decline. Staff interviews confirmed that there was no set toileting schedule beyond routine checks, and the LPN Unit Manager was unaware of the decline documented in the MDS. The resident was observed managing incontinence independently, sometimes without staff assistance, and at high risk for falls due to not locking wheelchair brakes and not using the call light. Another resident, with a history of neurogenic bowel, hemiplegia, and severe cognitive impairment, went six days without a documented bowel movement. The care plan included interventions such as monitoring and documenting bowel movements every shift and following a protocol for no bowel movement for three days, but these interventions were not implemented. Bowel documentation was inconsistent, with multiple shifts left blank and no PRN bowel medications administered during the period of constipation. The resident was eventually sent to the hospital for an unrelated change of condition and was diagnosed with a small bowel obstruction. Staff interviews revealed confusion about documentation codes and the bowel protocol, and the facility was unable to provide clear evidence of monitoring or interventions during the period of constipation. The facility's failure to follow its own policies and protocols for bowel and bladder management, including timely assessment, documentation, and intervention, resulted in residents not receiving appropriate care. The lack of comprehensive assessment and individualized care planning, as well as inconsistent documentation and unclear staff understanding of protocols, contributed to the deficiencies identified by surveyors.