Failure to Assist With Eating and Timely Continence Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary assistance with activities of daily living, specifically eating and continence care, for residents dependent on staff support. Facility policy required appropriate care and services for residents unable to carry out ADLs independently, including hygiene, mobility, elimination, and dining, in accordance with the care plan. One resident with hypertension, major depressive disorder, and a documented self-care performance deficit related to dementia had a care plan and physician’s order stating that she required feeding assistance with all meals, with staff to cue, encourage, and then assist if she was not eating. On the observed date, the resident was found asleep in bed when a staff member placed her lunch tray on the bedside table and left without providing cueing or assistance. Later observation showed the resident still asleep with the tray untouched and covered, and no staff were seen entering the room to encourage or assist with eating. Documentation for that meal indicated the resident refused to eat, recorded at a time prior to the tray being delivered. A prior nursing note documented that this resident required assistance and cueing for eating and was able to consume 95% of a meal when assisted. The DON stated she would have expected staff to encourage and assist the resident with eating. The deficiency also includes failure to provide timely continence care for another resident with hypertension and major depressive disorder. This resident’s call bell was observed on, and a staff member entered the room, told the resident to give them a minute, turned off the call light, and left. Later, the resident reported needing assistance with continence care because his skin was burning and stated he could not get to the restroom independently and required staff assistance. He was observed wearing a brief and activated his call light again. Another staff member entered, told him she needed to finish passing meal trays before returning to provide continence care, and left. Continence care was not provided until several minutes later. The resident’s care plan documented a self-care performance deficit related to a humerus fracture and that he required one-person assistance with transfer and ambulation using a rollator. The clinical record showed that wound care evaluated him the following day for a fungal rash with excoriation to the sacrum and bilateral buttocks, and the DON stated she expected staff to provide continence care in a timely manner.
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