Failure to Provide Timely Incontinent and ADL Care for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide timely incontinent care and assistance with activities of daily living (ADLs) to a dependent resident. The resident was an elderly female with Alzheimer’s disease, dementia, and anxiety disorder, with a Comprehensive MDS showing a severely impaired BIMS score of 5 and a need for substantial/maximal assistance with toileting, dressing, and personal hygiene. Her care plan required assistance from one staff member for toileting every two hours and as needed, with incontinent care after each episode. On the cited date, surveyors observed the resident sitting in her wheelchair with pajama pants stained brown from the crotch area and a noticeable stool odor; she was fidgeting and trying to grab clean clothes from her bed, and her verbalizations were incomprehensible. A hospitality aide present in the room stated the resident had a bowel movement and that she had informed a nursing assistant about an hour earlier that the resident needed to be changed. Further interviews revealed that the nursing assistant who had been caring for the resident was on break and had not informed the LVN that the resident required incontinent care before leaving. The LVN stated that the nursing assistant should have reported the need for care so that the LVN or another CNA could provide it, and acknowledged that residents not being provided incontinent care promptly could result in skin breakdown. The DON and the Administrator both stated their expectation that resident care, including incontinent care, be provided before staff go on break and that such care be provided promptly, with managers responsible for oversight. The facility’s policy on quality of life and ADL care for dependent residents required that residents unable to carry out ADLs receive necessary services to maintain grooming and personal hygiene. The resident’s family member also reported that they often observed the resident’s clothing soaked in urine, indicating ongoing concerns with timely incontinent care.
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