Failure to Provide Privacy During Perineal Care
Penalty
Summary
The facility failed to ensure personal privacy for one resident during perineal care when staff did not close the door or pull the privacy curtain. The resident was an elderly female with paranoid schizophrenia, severe cognitive impairment (BIMS score of 06), reduced mobility, gait abnormalities, muscle weakness, major depressive disorder with psychotic symptoms, edema, and total dependence on staff for toileting hygiene. Her MDS reflected she was always incontinent of bowel and bladder, and her care plan directed staff to check her frequently for incontinence and provide perineal care, including washing, rinsing, and drying the perineum and changing clothing as needed. During an observation, the resident’s room door was fully open, and from the hallway the surveyor could see the resident’s lower body fully exposed while a CNA provided perineal care without the privacy curtain drawn. When the surveyor knocked on the open door, the CNA responded “resident care” but did not stop or take any action to close the door or pull the curtain, and continued providing incontinent care with the resident exposed. After a second knock, the CNA again only stated “resident care” and completed the perineal care without providing privacy, then left the room to dispose of trash and soiled items. In an interview, the CNA acknowledged that facility expectations and procedures require closing the door or using the curtain during incontinent care and stated she believed the door had been closed but did not latch. The resident reported that the CNA had just changed her brief, that the door is typically closed for privacy during such care, and that the lack of privacy during this incident “did not make me feel good.” The DON and ADM both stated their expectations that staff close doors and/or pull curtains during incontinent care and characterized failure to provide privacy as a breach of dignity and a resident rights and privacy issue. Facility policies on Dignity, Resident Rights, and Perineal Care all require staff to promote and protect resident privacy, including bodily privacy, and to provide privacy by closing doors and curtains and draping the resident during personal care.
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