Failure to Maintain Resident Dignity and Privacy
Penalty
Summary
The facility failed to maintain resident dignity and respect for four residents by not ensuring proper coverage of their bodies and by not providing privacy covers for indwelling urinary catheter drainage bags. One resident, a female with severe cognitive impairment, hemiplegia, and total dependence on staff for activities of daily living, was observed in photographs provided by her family to be lying in bed with her gown pulled down, exposing her right shoulder and upper chest. Staff interviews confirmed that the resident required total care and that such exposure would be considered a violation of resident rights and dignity. The staff stated that rounds were performed every two hours, but they were unaware of the exposure until shown the photographs by the surveyor. Additionally, three other residents with indwelling urinary catheters were observed without privacy covers on their catheter drainage bags. Observations revealed that the catheter bags were visible and not covered as required by facility policy and standard practice. Staff interviews confirmed knowledge of the requirement for privacy covers, but they could not explain why the covers were not in place at the time of observation. The care plans for these residents did not consistently include interventions to ensure catheter bag privacy, and the staff responsible for catheter care acknowledged their responsibility but failed to implement the required measures. Facility policy reviews indicated that all staff were required to attend annual in-service training on resident rights and abuse prevention, and that catheter drainage bags should be covered with dignity covers. Despite these policies and training, the observed failures resulted in residents being exposed or having their catheter bags visible, which could compromise their dignity and psychosocial well-being. The surveyors did not receive a copy of the facility's Resident Rights Policy during their visit.