Failure to Provide Individualized Continence Care and Toileting Program
Penalty
Summary
A deficiency was identified when a resident with occasional urinary and bowel incontinence was not provided with appropriate services to maintain or improve continence. The resident was admitted with intact cognition and required staff assistance for toileting, hygiene, and transfers. The care plan indicated the resident should be maintained on a toileting program to promote dignity and prevent skin breakdown, with interventions such as monitoring for skin issues and using easily removable clothing. However, there were no updates to the care plan after the initial entry, and documentation showed that a toileting program trial had not been attempted, despite the resident's increasing incontinence episodes. Observations and interviews revealed that the resident expressed a clear preference not to wear adult briefs and requested assistance to use the toilet. The resident reported that staff did not respond to their calls for help, resulting in episodes of incontinence. The family member confirmed that the resident was able to use the toilet when out with family and that wearing briefs was not good for the resident's skin. Staff interviews indicated that the resident was capable of being toileted with assistance, but a toileting program was not implemented, and staff cited insufficient staffing as a barrier to providing this care. Further interviews with clinical and rehabilitation staff confirmed that the resident had not been placed on a toileting program, and there was no recommendation against toileting from the rehabilitation team. The nurse practitioner stated that the resident should be trialed with voiding if they were aware of their need to use the bathroom, and the DON stated the resident was not on a voiding program due to requiring two-person assistance for transfers. The lack of individualized continence care and failure to honor the resident's preferences led to the deficiency.