Failure to Provide Timely Toileting Assistance Resulting in Incontinence
Penalty
Summary
A deficiency was identified when a resident with Parkinson's disease and muscle wasting, who was moderately cognitively impaired and frequently incontinent of bowel and bladder, did not receive timely assistance to maintain continence. The resident required extensive assistance for toileting, as documented in the care plan. On the day of the incident, the resident requested to use the bathroom while being transported from the Activities room by two Activities Aides. Instead of assisting or notifying appropriate staff, the aides left the resident across from the nurses' station without informing anyone of her need to urinate. For over 35 minutes, the resident remained unattended and was not assisted to the bathroom, despite her repeated requests. Multiple staff, including the Activities Director and CNAs, interacted with the resident but did not provide or arrange for toileting assistance. The resident was eventually assisted to the bathroom nearly an hour after her initial request, at which point her brief was found to be wet with urine, though she was able to urinate in the toilet as well. Interviews with staff confirmed that the resident was usually continent if assisted in a timely manner, but delays often occurred, especially during busy periods such as mealtimes. The facility's policy on Activities of Daily Living emphasized the importance of preserving function, promoting independence, and maintaining dignity. However, observations and interviews revealed that staff failed to follow this policy, resulting in the resident experiencing discomfort and partial incontinence due to delayed toileting assistance. The deficiency was substantiated through direct observation, staff interviews, and review of facility records and policies.