Failure to Develop Comprehensive Toileting and Fall-Risk Care Plan for Cognitively Impaired Resident
Penalty
Summary
The deficiency involves the facility’s failure to develop a comprehensive, person-centered care plan addressing a cognitively impaired resident’s toileting needs and fall risk, including the absence of a scheduled toileting or prompted voiding program. The resident had osteoarthritis of the knee, anxiety, and Alzheimer’s dementia, with a BIMS score of 5 indicating impaired cognition, and was frequently incontinent of bowel and bladder without being on a toileting program. The Resident Care Plan identified self-care deficits related to weakness and deconditioning, dementia with an intervention to anticipate and meet needs, and potential for falls due to unsteady gait, with interventions such as supervised/touching assist for toileting and personal hygiene, use of non-skid socks, monitoring gait changes, and offering diversional activities including toileting and ambulating. However, the care plan did not include a structured toileting schedule or prompted voiding program despite the resident’s incontinence and cognitive impairment. The resident experienced an unwitnessed fall in the bathroom with a head strike, resulting in a frontal head hematoma and a painful right forearm, and was later diagnosed in the ED with a bicondylar intra-articular fracture of the distal humerus. At the time of this fall, the resident was assisted to the bathroom by a NA, who opened the bathroom door, observed the resident place a cane in the sink, then partially closed the door to provide privacy and turned away, subsequently hearing a sound and finding the resident on the floor. The DNS stated that the resident was care planned as a supervised assist of one for toileting and personal hygiene, meaning staff were to supervise the ADL to allow for cueing and assistance, and acknowledged that the NA did not have constant supervision because his back was turned. Subsequent nursing notes documented the resident being noncompliant with transfers, being found in the bathroom after asking to lie down, ambulating multiple times without assistance and not using the call light, and later being found lying on the bathroom floor again after using the bathroom, with severe pain and inability to move the left upper arm, and an ED diagnosis of a left displaced comminuted fracture of the distal humerus. The facility’s ADL policy and Fall Prevention Program required assistance per the person-centered care plan and incorporation of risk-based interventions into the care plan, which were not fully implemented regarding scheduled toileting and fall prevention for this resident.
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