Failure to Provide Timely Peri Care and Maintain Resident Dignity
Penalty
Summary
The deficiency involves the facility’s failure to provide timely perineal care and maintain dignity for a cognitively intact resident who reported being left in soiled briefs for extended periods, particularly at night. The resident, an older female with diagnoses including paranoid schizophrenia, abnormalities of gait and mobility, groin furuncle, dehydration, anxiety disorder, and hypocalcemia, required assistance with toileting transfers and supervision or touching assistance with toileting hygiene. Her MDS indicated bowel continence and no toileting program, and her care plan did not reflect any adverse reactions from prolonged exposure to wet briefs. Despite this, she stated in an interview that she was often left sitting in a wet brief for hours, which made her feel sad, hopeless, and helpless, and that she had reported this to the DON and Administrator without any change. Interviews with staff revealed inconsistent awareness and documentation practices related to toileting and incontinence care. The DON reported being unaware of residents being left in soiled briefs for hours and stated that staff were expected to check residents frequently and respond to call lights as soon as possible, but also acknowledged that staff did not document how many times they provided supervision or touching assistance or changed briefs, only documenting complications or abnormal behavior. The Administrator stated that no residents had approached him about being left in wet briefs and that he expected staff to respond to call lights promptly and conduct rounds every two hours, noting that failure to respond appropriately could create poor quality and poor resident satisfaction. Direct care staff interviews corroborated resident concerns about delayed incontinence care. CNA A stated that leaving a resident in a soiled brief was a form of neglect, that he made rounds at least every two hours, and that residents had complained to him about being kept in wet briefs for too long; he reported these concerns to the charge nurse but had not seen an outcome, and specifically noted that this resident had mentioned being left in soiled briefs once or twice. CNA B reported that staff should make rounds every two hours, that she typically did so every hour, and that she could document peri care in the Point Click Care system; she also stated that she had come on shift several times to find residents sitting in soiled briefs and attributed this to lack of structure, not lack of time. LVN A reported that residents had told her they were often left in wet briefs during the daytime, and when she informed the DON, the DON denied it, stating it was not true. Although skin assessments did not show breakdown for this resident, staff interviews acknowledged that prolonged exposure to soiled briefs could cause skin breakdown, and the facility’s Accommodation of Need policy emphasized residents’ rights to a dignified existence and to be treated with respect, kindness, and dignity, which were not upheld in this case.
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