Failure to Provide Required Overnight Incontinent Care and ADL Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide incontinent care and assistance with activities of daily living during the overnight shift for one resident. The resident had a BIMS score of 15/15, indicating no cognitive impairment, and required substantial/maximal assistance with toileting hygiene and personal hygiene due to bilateral upper and lower extremity impairments. The MDS documented that the resident was frequently incontinent of urine and always incontinent of bowel, with diagnoses including ulcerative colitis, paraplegia, anxiety, and depression. The resident’s care plan directed staff to change her disposable brief daily and as needed, check her for incontinence per her request and as required, wash, rinse, and dry the perineum, and provide peri care after each incontinent episode. During interview, the resident reported that on the overnight shift she was not being changed as she should be, stating that when she had a bowel movement and pulled her call light, staff would sometimes let the call light go unanswered or enter the room, state they would return, turn off the call light, and then not come back. She indicated this occurred about once a week and always when she was incontinent of urine, and that staff would not assist her with incontinent cares; she also reported having issues with skin in the affected area and the use of cream to help prevent skin issues. Two CNAs confirmed that the resident had complained to them about overnight staff not cleaning her up after incontinence and described that overnight staff were not very good about ensuring residents were not wet and that not all staff cleaned her properly when bowel movements came up the front. The Administrator stated she was not aware of issues with overnight incontinent care, while the DON stated staff were expected to round every two hours to check and change incontinent residents and offer or remind toileting, consistent with the facility’s ADL policy requiring care according to the individualized care plan.
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