Failure to Provide Proper Perineal Care and Assessment During Incontinent Care
Penalty
Summary
Certified Nursing Assistants (CNAs) failed to provide appropriate perineal care to a female resident who was frequently incontinent of bladder and bowel and required total assistance with activities of daily living. During an observed episode of incontinent care, a CNA did not separate the resident's labia while cleaning, instead wiping between the closed peri area multiple times without visualizing the area. The resident expressed pain during the process, and bright red blood was noted on the wipes. The CNA did not stop care or notify the nurse as required when the resident reported pain and bleeding. Interviews with staff confirmed that the expected procedure was to separate the labia and clean each side and the middle with separate wipes, and to notify the nurse if there was pain or bleeding. The resident had a history of morbid obesity, diabetes, hypertension, and cerebral infarction, and was assessed as having moderately impaired cognition. The care plan specified prompt changing and application of a protective barrier to the skin. The facility's policy required separating the labia and cleaning from front to back to prevent infection. Staff interviews revealed knowledge of the correct procedure, but it was not followed during the observed care, resulting in inadequate cleaning and failure to assess the source of bleeding.