Failure to Provide Timely Incontinence Care Following Call Light Activation
Penalty
Summary
A deficiency occurred when staff failed to provide timely assistance to a resident who required help with incontinence care. The resident, who was cognitively intact and had a care plan addressing bowel and bladder incontinence due to impaired mobility and general weakness, activated the call light after a bowel movement. Despite the facility's policy requiring call lights to be answered within a reasonable time and care needs to be met before turning off the call light, the resident waited nearly an hour before being attended to. Two CNAs responded to the call light but did not provide immediate care; instead, they turned off the call light and left the room to locate the assigned CNA, delaying the resident's care further. Interviews confirmed that the CNAs were aware of the resident's need but did not act promptly, and the assigned CNA only provided care after being informed at the nurses' station. The Director of Nursing verified that the response time was not acceptable and that the CNAs should have provided care immediately rather than leaving the resident unattended. The resident expressed distress over the delay, stating she had not been changed since early morning and was upset by the lack of timely assistance.