Failure to Provide Timely and Hygienic Incontinence Care
Penalty
Summary
The deficiency involves failure to provide timely and complete incontinence care and proper peri-care technique for two residents. One resident with dementia, CKD stage 3, polyneuropathy, osteoarthritis, depression, a history of pressure ulcers, and documented bowel and bladder incontinence was care planned as dependent on staff for toileting, bathing, and personal hygiene, with interventions including peri-care after each incontinent episode and use of barrier products. Surveyors observed this resident’s bed linens saturated with urine and noted a strong urine odor when the resident was transferred from bed to a recliner. On the following day, the resident reported during breakfast that she had not been cleaned up, remained wet from overnight, and later that morning still had not been checked or cleaned. When CNAs eventually provided peri-care, the incontinence brief was observed to be saturated with urine. CNAs interviewed stated they check residents every two hours and perform incontinence care when getting residents up in the morning, indicating a delay between overnight incontinence and morning care for this resident. The second resident, cognitively intact and always incontinent of bowel and bladder per the MDS and care plan, was to be checked and changed every two hours and PRN. During observed incontinence care, the resident was incontinent of urine and stool. CNAs cleansed only part of the buttocks and anal area, then repositioned the resident onto her back on a stool-soiled bath blanket. While cleansing the peri-area and inner thighs, the resident’s stump moved through stool, and the CNA touched the pubic area with soiled gloves, leaving stool on the pubis. The resident was then turned again and the anus and inner thighs were cleansed. These actions did not follow the facility’s Incontinent Care policy, which requires washing all soiled skin areas, drying well, and changing gloves and performing hand hygiene as required to prevent cross-contamination.
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