Failure to Provide Reasonable Accommodation for Toileting Needs
Penalty
Summary
A deficiency occurred when the facility failed to promote independence and autonomy in toileting for a resident with Alzheimer's disease, dementia, anxiety disorder, and cognitive communication deficit. The resident was admitted to a room with a nonfunctioning toilet, and the bathroom remained out of order and padlocked from the time of admission. Despite the resident's ability to ambulate and use the toilet independently, she became confused due to the lack of access to a working bathroom, resulting in episodes of urinating and defecating in inappropriate places such as laundry baskets, the floor, trashcans, and her closet. Staff interviews and progress notes confirmed that the resident was provided with a bedside commode as an alternative, but she continued to experience confusion and incontinence incidents. Staff reported that the resident would get lost or confused trying to find communal bathrooms down the hallway, and required redirection and assistance. The shared bathroom attached to her room was not accessible from her side and was also nonfunctional, further limiting her options. Maintenance staff indicated that the bathroom had been out of order since July due to a clog, and it was not prioritized for repair. The Director of Nursing and other staff acknowledged that the resident remained in the room with the nonfunctioning toilet for an extended period, despite the availability of other rooms with working bathrooms. The decision to keep the resident in the room was based on proximity to the nurse's station, and there was no documentation of consideration for moving her to a more suitable room until much later. After being moved to a room with a functioning bathroom, the resident no longer experienced inappropriate toileting incidents.