Failure to Provide and Document Timely Incontinence and Toileting Care
Penalty
Summary
Surveyors identified a deficiency in the facility’s provision of toileting and incontinence care for a resident who was always incontinent of bowel and bladder and required assistance with turning, repositioning, personal hygiene, and toileting. The resident, who had diagnoses including arthritis, COPD, and heart failure and was on diuretic therapy for edema, reported being wet and not having been changed since 5:00 a.m., and stated that staff typically did not change them until they were dressed around 11:00 a.m. During a morning observation, the resident was found lying in bed and reported being wet, and on another morning observation, there was a noticeable urine odor in the resident’s room while the resident was in bed eating breakfast. The resident reported having open areas in the groin and using a medicated barrier cream they had purchased, while the facility provided another type of barrier product. During an observed assessment of the groin area with an LPN, the resident’s incontinence brief appeared dry at that time, but the groin area outside the brief was excoriated, and the LPN then provided incontinence care. Staff interviews indicated that CNAs were expected to receive report from the prior shift, round on residents in the morning to ensure they were clean, and check residents for incontinence every 2–3 hours, with more frequent checks for heavy wetters. Staff also stated that if a resident refused to be changed, they were to re-approach and involve additional staff and a nurse if refusals continued, and that this resident was able to make needs known. Review of the CNA documentation for bladder function over a 14‑day lookback period showed multiple gaps and inconsistencies in recorded episodes of continence and incontinence across all three shifts. There were instances where several episodes of incontinence were documented within short time frames, followed by long periods with no documentation for an entire shift or more than 14–24 hours between entries. The unit manager and DON both stated that CNAs were supposed to document toileting and incontinence care as it occurred, that staff should be rounding every two hours and per resident request, and confirmed that toileting episodes were not consistently documented. The DON acknowledged that if care was not documented, it was considered not done, highlighting missing documentation for toileting and incontinence care for this resident.
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