Failure to Provide Timely Incontinence Care to Dependent Residents
Penalty
Summary
The facility failed to provide timely assistance with Activities of Daily Living (ADL), specifically incontinence care, to residents who were dependent on staff. Three residents with significant medical conditions, including multiple sclerosis, obesity, congestive heart failure, neuromuscular dysfunction of the bladder, hemiplegia, hemiparesis, and dementia, were identified as being completely dependent on staff for toileting and personal hygiene. These residents were always incontinent of bowel and bladder and required the use of mechanical lifts for transfers. Observations and interviews revealed that residents waited extended periods for incontinence care. One resident reported waiting from late morning until the next shift for toileting assistance, with staff confirming that the resident's incontinence brief was extremely soiled with urine and bowel movement by the time care was provided. Another resident stated that it took over an hour for staff to arrive to change a soiled brief, and that the same brief had been worn since early morning. A third resident reported routinely waiting about an hour for CNAs to respond to requests for incontinence care on both first and second shifts. Record reviews and staff interviews indicated that staff were expected to check and change incontinence briefs every two hours, regardless of whether residents could verbalize their needs. However, staff did not consistently offer or provide incontinence care at the required frequency, and communication lapses between shifts contributed to delays. Facility policies required residents to be kept dry, comfortable, and odor-free, with incontinence care provided every two hours or more frequently as needed, but these standards were not met for the residents reviewed.