Failure to Provide Timely Incontinence and Toileting Care
Penalty
Summary
The deficiency involves the facility’s failure to provide required assistance with activities of daily living, specifically toileting hygiene and incontinence care, for one resident. The resident had diagnoses including hemiplegia and hemiparesis, muscle disorders, hypertension, history of falling, and vitamin D deficiency, and had a Brief Interview of Mental Status score of 10, indicating moderate cognitive impairment. The resident’s MDS Section GG documented that toileting hygiene required a code of 01 (dependent), meaning staff must perform all of the effort. The resident’s care plan, initiated for bladder and bowel incontinence related to impaired mobility, directed staff to check and change the resident every 2–3 hours and as needed. Facility policy on incontinence care required incontinent residents to be checked periodically in accordance with assessed incontinent episodes or every two hours and to receive perineal and genital care after each episode. Record review showed a toileting hygiene task documented at 12:14 a.m. on a specific date, with no toileting hygiene time recorded for the 7:00 a.m.–3:00 p.m. shift that same day. Late in the morning, the resident reported not having been changed since 8:30 p.m. the previous evening. Observation shortly thereafter revealed the resident’s incontinence brief contained a dark yellow liquid substance in both the front and back. An LPN confirmed that the brief did not appear to have been changed during the current shift and appeared filled with urine. A CNA stated that residents are checked every two hours or more frequently for incontinence care, that the resident was not in her assignment, but that the resident should have been changed at least once that shift and more often if necessary. The DON stated residents should be changed at least twice a shift, at the beginning and end of the shift, and more frequently if necessary. These observations and interviews showed that the resident was not checked and changed in accordance with the care plan, facility policy, and stated practice.
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