Failure to Ensure Resident Privacy During Personal Care
Penalty
Summary
The facility failed to ensure privacy during care for three residents when certified nursing assistants (CNAs) did not fully close privacy curtains while providing activities of daily living (ADLs), including incontinent care. Observations revealed that in each instance, the privacy curtain was only halfway closed, and in one case, the bedside window curtains were also open, making the resident visible from outside. These lapses occurred while residents were exposed or naked during personal care. Resident 2, who had diagnoses including generalized muscle weakness, lymphedema, and morbid obesity, was observed receiving incontinent care with the privacy curtain only halfway closed and the window curtains open. Resident 2 was able to make decisions and expressed feeling embarrassed and unsafe when privacy was not maintained. Resident 3, with severe cognitive impairment and requiring assistance for ADLs, was observed naked during care with the privacy curtain only partially closed. Resident 4, also with severe cognitive impairment and requiring maximum assistance, was observed fully exposed while the privacy curtain was only halfway closed during cleaning. Interviews with the CNAs involved confirmed their awareness of the importance of closing curtains to maintain resident privacy and dignity. Additional interviews with nursing staff, including an LVN and an RN, reiterated the facility's expectations for privacy during care, such as closing doors and curtains and knocking before entering. Review of facility policies confirmed the requirement to promote and protect resident privacy, including bodily privacy during personal care and treatment procedures.