Failure to Provide Timely Incontinence and ADL Care
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary assistance with activities of daily living and incontinence care to keep a resident clean, dry, and comfortable in accordance with the resident’s needs and the facility’s own policy. The resident had diagnoses including muscle weakness and hypertension, fluctuating capacity to understand and make decisions, and required varying levels of assistance for ADLs, including dependence for toileting hygiene and lower body dressing. The resident’s care plan indicated assistance with ADLs as needed. On the survey date, the resident reported not being cleaned all morning and sitting in urine for hours, despite repeatedly calling staff for help. Observations showed the resident using the call light while a CNA walked past the room without responding. The resident stated that staff did not respond to call lights and ignored her. During subsequent observations and interviews, CNA 1 stated she was too busy to assist the resident, citing responsibility for nine residents and indicating she had already responded several times to requests to adjust the bed. CNA 1 left the room while the resident verbally expressed discomfort and a need for help. When CNA 2 entered, the resident again requested to be cleaned, but CNA 2 stated she could not clean the resident because she was about to pass meal trays and asserted that residents had to wait during tray pass per facility rules. CNAs stated they could not clean residents during tray pass and that all residents had to wait. Later, CNA 2 told the Infection Prevention Nurse that the resident had refused care that morning, while the resident stated CNA 2 had never asked to clean her. The facility’s bowel and bladder policy required that incontinent residents be kept clean, dry, and comfortable, and the DON acknowledged residents should not be left in urine for a long period of time because it could lead to skin breakdown and make residents feel neglected or ignored.
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