Failure to Implement Scheduled Toileting Program for Identified Resident
Penalty
Summary
A deficiency occurred when a resident, who was identified as a candidate for scheduled toileting based on assessments and physician's orders, did not receive the required toileting retraining plan. The resident had multiple diagnoses, including chronic obstructive pulmonary disease, need for assistance with personal care, and severe cognitive impairment. Facility records, including the Minimum Data Set and Bowel and Bladder Program Screener, indicated the resident should have been placed on a scheduled toileting program for 90 days, with specific interventions such as offering toileting at set times and documenting each occurrence. Despite these documented assessments and orders, interviews with facility staff revealed that the scheduled toileting program was not implemented. The assigned CNA was unaware of the toileting plan, and the charge nurse did not know the resident was on such a program, instead deferring responsibility to the MDS nurse. The MDS nurse confirmed that, although the resident was identified as a candidate, there was no evidence in the medical record that the scheduled toileting program had been initiated or documented for the resident during the specified period. The Director of Nursing acknowledged that the facility failed to implement the scheduled toileting plan, despite the resident's assessment and physician's order. Facility policy required staff to provide appropriate services and treatment to help restore or improve bladder function, including scheduled toileting for those identified as candidates. However, the lack of communication and documentation among staff resulted in the resident not receiving the scheduled toileting intervention as required.