Failure to Provide Timely Toileting and Incontinence Care
Penalty
Summary
The deficiency involves the facility’s failure to provide timely toileting and incontinence care to residents who were dependent on staff for these activities of daily living. One resident with hemiplegia, anoxic brain damage, neuralgia, depression, anxiety, low back pain, weakness, cognitive communication deficit, and muscle wasting required a mechanical lift with two staff for transfers and was care planned to be toileted at regular intervals, including before and after meals, activities, naps, and at bedtime. The MDS documented that this resident was cognitively intact, dependent on staff for toileting, and frequently incontinent of bladder and bowel. The resident reported that staff typically changed her brief only when getting her up around late morning and again when putting her to bed in the evening, and that staff told her if she requested a change after early afternoon, she would be transferred to bed and have her brief changed but would have to remain in bed until the next shift began. During observation, when the resident requested a brief change early in the afternoon, a CNA confirmed she would transfer the resident to bed and change her but stated the resident would need to remain in bed until the next shift because the CNA had not yet had a break and needed to complete rounds before the end of her shift. This practice conflicted with the expectations stated by the DON and Administrator, as well as with the facility’s written incontinence care guidelines requiring assistance after incontinent episodes and at least every two hours based on care planning. Another resident, with diagnoses including cerebral infarction, cirrhosis, depression, anxiety, seizures, encephalopathy, schizoaffective disorder, dementia, hemiplegia, abnormal gait/mobility, weakness, and a history of falls, was care planned as incontinent of bowel and bladder, to be checked every two hours, toileted at regular intervals, and assisted with toileting as needed. The care plan also noted that this resident’s ADL needs, including transfers and toileting, could fluctuate with acute changes or exacerbations of chronic conditions. The MDS showed the resident had intact cognition, required substantial/maximal assistance for toileting, and supervision/touching assistance for transfers. The resident reported that on one evening she activated her call light because she needed to use the bathroom but was not assisted for approximately three hours, during which time she wet the bed. These findings demonstrate that staff did not provide toileting assistance and incontinence care in accordance with the residents’ assessed needs, care plans, and facility policy.
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