Failure to Provide Timely ADL and Incontinence Care and Respond to Call Lights
Penalty
Summary
The deficiency involves the facility’s failure to provide timely and adequate assistance with activities of daily living (ADLs), including toileting and incontinence care, to multiple dependent residents. One resident with hemiplegia, dementia, malnutrition, pelvic fractures, and a sacral pressure ulcer was assessed as cognitively intact but dependent on staff for toileting hygiene, bathing, and dressing, and required substantial/maximal assistance with toileting transfers. Family members reported that CNAs did not check on this resident unless the call light was activated and that call light responses took between forty-five minutes to two hours. They also stated that staff placed briefs on the resident and told them he was incontinent, despite the resident being able to verbalize the need to use the restroom and having requested a urinal, and that attempts to meet with nursing and administrative staff about these concerns were unsuccessful or significantly delayed. Another cognitively intact resident with paraplegia, hemiplegia, neuromuscular bladder dysfunction, bowel and bladder incontinence, and a pressure ulcer was care planned as dependent for ADLs and at high risk for abuse and neglect, with staff expected to provide incontinence care as needed and maintain privacy and dignity. This resident reported not being checked or changed during an evening shift until late in the shift and stated that on a subsequent morning she had not been checked or changed since early morning rounds, despite informing a CNA that she needed to be cleaned before wound care. The resident continued to use the call light while the CNA was in neighboring rooms, and care was not provided until several hours later. The wound nurse confirmed that wound care was delayed until after the CNA staff eventually provided hygiene. A nurse stated that this resident frequently complains and refuses care, but progress notes over a month-long period did not document refusals or behavioral issues. A third cognitively intact resident, totally dependent for toileting due to bowel and bladder incontinence and at high risk for falls, was reported by a family member to often be found soiled with feces and to experience call light response delays of over an hour. The family member stated she had to supply her own briefs and wipes and visited multiple times daily to ensure the resident was fed and changed, and had previously submitted a concern form about call light response and toileting that she felt had not been resolved. A fourth resident with severe back pain, decreased mobility, and decreased ADL function required assistance of one staff member for ADLs and reported having a large bowel movement on the overnight shift but not being fully cleaned. The resident stated that the CNA told him the overnight shift does not provide showers or wash-ups and that he would have to wait for the next shift, and the day nurse later confirmed she had not been informed of the need to clean or shower the resident and had not tended to him. Multiple staff, including CNAs and nursing leadership, stated that residents should be rounded on at least every two hours, call lights should be answered as soon as possible by any available staff, and soiled residents should be addressed immediately, including on overnight shifts, which was inconsistent with the care described by residents and families.
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