Failure to Provide Timely Incontinence and ADL Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide timely incontinence care and assistance with ADLs to residents who were fully dependent on staff for toileting hygiene and bed mobility. One resident, admitted with generalized osteoarthritis, adult failure to thrive, chronic pain syndrome, and a history of venous thrombosis and embolism, had an MDS indicating no cognitive impairment but total dependence on staff for toileting hygiene, lower body dressing, and rolling in bed, and was always incontinent of bowel and bladder. The resident’s care plan called for skin care after each incontinent episode, incontinence care as needed, assistance with ADLs, and monitoring of skin integrity during routine care. During observation, the resident reported that CNAs changed her incontinence brief before bed around 10:30–11:00 PM and did not return until about 5:00 AM for medications and around 6:00 AM for a brief change, stating this occurred nightly, including the previous night. At 11:04 AM on the day of survey, the resident stated she was still wearing the same brief that had been applied around 6:00 AM, that it was soiled, and that she needed to be changed. A second resident, with a history including palliative care, obesity, osteoarthritis, and hypertension, also had an MDS showing no cognitive impairment, total dependence on staff for toileting hygiene, lower body dressing, and rolling in bed, and was always incontinent of bowel and bladder. This resident’s care plan documented a self-care deficit in bed mobility, need for assistance with daily care due to weakness and impaired mobility, and risk for altered skin integrity related to weakness, osteoarthritis, and incontinence, with interventions including skin care and keeping the resident clean and dry after each incontinent episode, assistance with ADLs, and monitoring skin integrity. The resident reported that her incontinence brief was typically changed before sleep around 10:00–10:30 PM and not changed again until about 5:00–6:00 AM, and that this occurred every night. In the afternoon, she stated her brief was currently soiled, she was waiting to be changed, and that it had not been changed since early that morning around 5:30 AM. The DON stated that staff are expected to reposition and change incontinent briefs at least every two hours for all residents to prevent infection and skin breakdown, and the facility’s ADL policy described a program of assistance with elimination and hygiene as required.
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