Failure to Provide Required Two-Person Assistance During Resident Care
Penalty
Summary
A deficiency occurred when a certified nursing assistant (CNA) performed incontinent care and dressing for a resident who required two-person assistance, without obtaining help from another staff member. The resident in question had a history of non-traumatic intracerebral hemorrhage, hemiplegia, hemiparesis, severe cognitive impairment, and was documented as totally dependent on two or more staff for activities of daily living such as toileting hygiene and dressing. The resident's care plan and Minimum Data Set (MDS) both specified the need for two-person assistance for these tasks. During the observed incident, the CNA did not request assistance and completed the care alone, despite being aware of the resident's care plan requirements. The CNA stated that it was sometimes difficult to find another staff member to assist during the night shift and admitted to feeling confident in her ability to perform the task alone. The resident's responsible party (RP) was present and noted that this was not the first time the CNA had performed care alone, and that he usually assisted with such tasks. Interviews with other staff, including another CNA, registered nurses (RNs), the assistant director of nursing (ADON), director of nursing (DON), and the administrator, revealed that there were established systems (care plans and Kardex) to communicate care requirements. However, the CNA did not seek assistance from available staff, and the nurses were not aware that the care was performed alone. The facility's process involved verbal communication of changes and oversight by nursing staff, but in this instance, the required two-person assistance was not provided as per the resident's care plan.