Failure to Provide Adequate Incontinence and Oral Care for Dependent Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate incontinence and oral care to dependent residents. One resident with multiple serious diagnoses, including Multiple Sclerosis, paralytic syndrome, and dysphagia, was documented as totally dependent for ADLs and always incontinent of bowel with an ileostomy. During a bed bath, a hospice CNA observed a medium-sized bowel movement and dried feces on this resident’s buttocks, stating it was “really dried on” and required effort to remove with warm soap and water. The resident reported not being checked during the night or early morning, stated that dried stool was left on him very often, and that he sometimes had to wait long enough for stool to dry. The observed personal care did not include oral care, and the resident stated he does not receive oral care very often and is unable to perform it independently. Another resident, admitted with multiple myeloma, pulmonary embolism, and other chronic conditions, was documented as always incontinent of bowel and occasionally incontinent of urine, requiring substantial assistance with mobility. A family member reported that during a visit, this resident had a bowel movement that was pasted to her bottom. A CNA who worked that day stated they believed the resident was dying and that when they went in to turn her, she was resting. The hospice CNA reported having seen dried bowel movements on this resident and described it as “sort of a normal thing,” noting that the resident frequently complained of pain during care, which the CNA reported to the charge nurse. A third resident with Parkinson’s disease, severe dementia, heart failure, and adult failure to thrive was documented as totally dependent on staff for ADLs, including oral care, and always incontinent of both bowel and bladder. This resident was not on a bowel program and was not toileted. Observation found the resident in a geri chair with poor oral hygiene, including teeth covered in a whitish-yellow, fuzzy substance, after receiving personal care that did not include oral care. The hospice CNA stated she had found dried feces on this resident several times and that the resident was usually soaked in urine. Additional CNAs acknowledged that they have found residents with dried bowel movements, with one CNA stating that oral care should be part of morning care and another attributing the issue to some staff lacking compassion. The facility’s perineal care policy states that the purpose of the procedure is to provide cleanliness and comfort, prevent infections and skin irritation, and observe the resident’s skin.
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