Failure to Provide Timely Incontinence and ADL Care, Including Hygiene and Grooming
Penalty
Summary
The deficiency involves the facility’s failure to provide timely and adequate ADL and incontinence care, as well as grooming and hygiene, for two residents who were dependent on staff for these needs. One resident with Alzheimer’s disease, dementia, bowel and bladder incontinence, and significant cognitive and communication impairments was reported by a family member to be frequently found soiled with urine and feces, with feces on her hands, face, and hair. On observation, this resident was nonverbal, confused, and required total assistance with ADLs and transfers. When checked by the ADON and an LPN, her brief was found soiled with urine, and her sacral and buttocks area showed multiple superficial open wounds/excoriations, redness, and dark discoloration extending to the inner thighs, as well as bilateral heel redness, dry peeling skin, and a dark scab on the right heel. The assigned CNA stated she had not yet provided morning or incontinence care, although she had fed the resident, and there were no reports to the LPN about the skin issues. A second resident, on respiratory isolation for COVID-19 and with diagnoses including cerebral palsy, COPD, arthritis, and bowel and bladder incontinence, was found in a room lacking appropriate isolation supplies on the isolation cart and without an isolation waste bin inside the room. The resident reported she had not received a bath or shower since receiving ashes on her forehead several days earlier and stated she had not been provided morning care and was soiled. On observation, she had facial hair, long nails with black matter under them, and was lying on a low air loss mattress with the machine on the floor. When repositioned by an LPN and a CNA, her brief and bed linens were found soaked with urine, and incontinence care was then provided. The resident denied refusing care, and progress notes over several days documented no refusal of care. Staff interviews revealed confusion and inconsistency regarding CNA assignments and responsibilities for providing ADL care, including nail care and shaving. One CNA who assisted with incontinence care for the second resident stated she was not the assigned CNA and did not know who was assigned, while the LPN who made assignments stated that CNA was in fact assigned to the resident. Another CNA reported that for the second resident she routinely started rounds for incontinence care only after passing breakfast trays, and that she did not provide morning care or a bed bath, limiting care to incontinence care and changing the gown and bed sheets. The facility’s policies required incontinent residents to be checked periodically or every two hours and to receive perineal care after each episode, and described grooming tasks such as shaving and nail care as part of ADLs, but the facility had no separate policy on nail care and facial shaving for female residents.
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