Failure to Validate Competency of Registry CNA Resulting in Harm from Improper Continence Care
Penalty
Summary
The facility failed to ensure that nursing staff, specifically a night shift certified nursing assistant (CNA) from a staffing agency, were competent to provide continence care for a resident. The CNA did not have documented competency validation before working on the floor and was identified as having improperly applied incontinence briefs, resulting in double briefing. The inner brief had a hole cut through the center with the resident's penis pulled through, which was too tight and caused swelling, pain, and discoloration. The resident, who had a history of prostatic hyperplasia and obstructive uropathy, required hospital evaluation due to these injuries. Interviews with staff confirmed that registry CNAs did not receive formal orientation, training, or facility-specific policy information before starting work, and there was no practice of shadowing or skills checklist completion for registry staff. Record review showed that the only skills checklist available was from a different facility, completed after the CNA had already been terminated, and was incomplete with no supervisory validation. The facility was unable to provide documentation verifying the CNA's competencies or a policy on the use of registry staff. The nurse administrator acknowledged that without competency validation, the facility could not guarantee resident safety, and the resident experienced psychosocial harm and pain as a result of the improper continence care provided by the unverified CNA.