Inadequate Perineal Care for Incontinent Resident
Penalty
Summary
The facility failed to provide appropriate incontinence and perineal care to a female resident who was frequently incontinent of bladder and bowel and had multiple comorbidities, including a hip fracture, type 2 diabetes mellitus, dementia with moderate cognitive impairment (BIMS score 8/15), and chronic kidney disease. Her comprehensive care plan documented bowel and bladder incontinence related to dementia, hospice status, weakness, impaired mobility, and pain, with interventions to check her every two hours, assist with toileting as needed, and provide peri care after each incontinent episode. During an observation, CNA-B removed the resident’s soiled brief and cleaned only the right and left groin areas, then turned the resident to her right side and cleaned the buttock and rectal area before applying a clean brief. The observation further showed that CNA-B did not clean the resident’s suprapubic area and did not open the labia while cleaning the genital area, contrary to the facility’s perineal care policy, which directs staff to wipe across the pubis area and, for female residents, to wipe one side of the labia majora from front to back to avoid contaminating the urethral area. In a subsequent interview, CNA-B acknowledged she did not clean the suprapubic area or open the labia, stating she was nervous and forgot, and confirmed she had received peri-care training in the prior year. The DON also stated that CNA-B should have cleaned the suprapubic area and opened the labia area to prevent possible infection and confirmed responsibility for providing peri-care training and monitoring skill checkoffs.
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