Failure to Provide Required Bathing and Timely Incontinence Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide required ADL assistance, including timely incontinence care and bathing at least twice weekly, for residents dependent on staff. One resident was observed lying in bed with an uncovered, visibly saturated incontinence brief and reported waiting to be cleaned. Her call light was not activated until prompted, and although an RN responded and stated the CNA would be notified, incontinence care was not provided until over 30 minutes later. The resident, who had chronic kidney disease, a history of UTIs, diabetes mellitus, and was always incontinent of bowel and bladder per MDS, reported that she sometimes went one to two weeks without a bath and had previously gone six weeks without being bathed. Review of her care plan and shower schedule showed she was to receive bathing twice weekly with bed baths on non-shower days, but bathing records documented multiple missed scheduled baths over several months. A second resident’s closed record showed she was cognitively intact, always incontinent of bowel and bladder, and dependent on staff for toileting, bathing, and hygiene. Her care plan required assistance with ADLs and hygiene, and a later care plan noted she was resistive to care, with interventions to allow her to make decisions and be educated on outcomes of non-compliance. The shower schedule indicated twice-weekly bathing, but bathing input forms showed she received only three of eight scheduled baths in one month, a single bed bath in the following month, and no showers or baths in the subsequent month before discharge. Several scheduled bathing dates were left blank or marked non-applicable, and there was no documentation that she refused or resisted bathing. The DON confirmed she could not locate documentation of refusals and acknowledged a lack of twice-weekly bathing. A third resident, who had diabetes mellitus and schizophrenia and was dependent for toileting and bathing per MDS, stated she only received bathing when she asked staff. Her care plan required assistance with ADLs and hygiene, and the bathing schedule called for twice-weekly evening baths. Bathing input forms showed she received only four of eight scheduled baths in one month and five of nine in the next, with multiple dates marked non-applicable. The DON was unable to provide additional information or documentation explaining the missed baths. Facility policies on ADLs and bowel and bladder incontinence required that residents unable to perform ADLs receive necessary services to maintain personal hygiene and that staff routinely provide incontinence care, including brief changes, pericare, and clothing and linen changes, which were not consistently carried out for these residents.
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