Failure to Provide Timely Incontinence Care and Grooming for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide timely incontinence care and grooming assistance to dependent residents. One resident who was nonverbal, on hospice, and required check-and-change incontinence care every two hours was observed lying in bed in urine-soaked linens for an extended period. Surveyors first observed a wet, yellow circle under the resident’s buttocks and feet at 9:48 AM, with a strong urine odor noted later, and the resident remained in the same wet position through at least 12:14 PM while being fed lunch in bed. The resident was not changed until 12:32 PM, at which time staff found the disposable brief, bed pad, and bottom sheet saturated with urine. The CNA assigned to the resident stated the resident was difficult to care for because she “be fighting,” although the resident did not resist care during the observed change. Documentation showed no urinary continence task entries for that day and indicated the last recorded change occurred the previous evening, despite the resident’s care needs and hospice status. Another resident with multiple sclerosis, morbid obesity, impaired mobility, neuromuscular bladder dysfunction, and no cognitive impairment reported being dependent on staff for toileting and always incontinent of bowel and bladder. This resident stated she wore two incontinence pads and sat on an additional pad in her chair because staff did not change her after she got up in the morning and that staff often told her they were busy or lacked help when she requested toileting. She reported remaining up for many hours without being changed and expressed a desire to be changed at least once after getting up. A third resident, a ventilator-dependent individual with severe intellectual disabilities and dependent on staff for ADLs, was observed with visible facial hair on the upper lip and chin, approximately 1/8 to 1/4 inch long, noticeable from halfway across the room. The resident’s guardian confirmed the resident was nonverbal, dependent on staff, and needed shaving, and facility records showed she was dependent on staff for shaving and did not reject care, with no documentation of care refusal in behavior tasks.
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