Failure to Honor Resident Refusal and Maintain Dignity During Incontinence Check
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to refuse care and to be treated with dignity and respect. Resident #1, who had a BIMS score of 14 indicating intact cognition, adequate hearing and vision, and no behavior issues, required total staff assistance with toileting and hygiene and was frequently incontinent of bowel. The resident’s care plan directed staff to follow facility protocol as the resident allowed for incontinence care, to assist with toileting, and to ask yes/no questions to determine the resident’s needs. An intervention also documented that the resident preferred to be changed between 1:00 AM and 3:00 AM. On the overnight shift at approximately 2:00 AM, Staff A, a CNA, entered Resident #1’s room to perform a check and change. Resident #1 told Staff A that she was dry and did not want to be bothered. Despite this clear refusal, Staff A proceeded to check the resident by placing a hand between the resident’s thighs to feel the outside of the brief. Resident #1 reported that she was dry and that the gesture made her uncomfortable. Staff A then left without changing the resident. During the next rounds, when Staff A again attempted to check the resident, Resident #1 again stated she did not want to be bothered, and at that point Staff A stepped away and obtained the nurse. Resident #1 later reported the incident to staff, including therapy and nursing personnel, describing that Staff A had placed hands between her thighs to check the brief after she had refused care. The resident stated that she felt uncomfortable and fearful that Staff A would not respect her wishes regarding being checked and changed, and she reported having trouble sleeping related to the incident. Multiple staff interviews, including with the RN, CNA, Occupational Therapy Assistant, Social Services, and the DON, confirmed that the resident had described the same sequence of events and that Staff A acknowledged proceeding with the check despite the resident’s refusal. The facility’s own Resident Rights acknowledgement stated that residents must be cared for in a manner that promotes maintenance or enhancement of quality of life and dignity, in full recognition of individuality, which was not followed in this incident.
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