Failure to Provide Timely Incontinence Care and Improper Use of Multiple Briefs
Penalty
Summary
The deficiency involves the facility’s failure to provide timely incontinence care and appropriate ADL assistance to a resident with urinary incontinence, as well as the inappropriate use of multiple incontinence briefs. On one date, surveyors observed the resident lying in bed with visibly wet pants and a noticeable urine odor in the room at midday. Over two hours later, the resident’s pants remained wet, with the wet area only beginning to fade. The CNA assigned to the resident stated he checked residents every two hours and had last checked this resident before lunch, and later reported he had just changed the resident and found him wet. The resident’s clinical record showed diagnoses including benign prostatic hyperplasia without lower urinary tract symptoms, vascular dementia, and intellectual disability, and the care plan directed staff to assist with routine toileting, check routinely for incontinence, provide incontinence care as needed, and encourage the resident to allow staff assistance when incontinent. On another date, the same resident was observed lying in bed with at least two incontinence pads under him and a visible ring of urine around him on the bed. Later observations that day showed an even darker ring of urine and an additional lighter, drying ring, with the resident remaining in the same position and the bed still wet. The CNA reported he had last changed the resident earlier that morning and that the resident had not refused care. During an ADL care observation, the CNA initially stopped at the door when he saw the resident sleeping and did not check for incontinence until prompted by the surveyor. When prompted to educate the resident and request permission to provide care, the resident got up and allowed the CNA to change him. At that time, the resident had two soaked incontinence pads, a soaked brief, a soaked red shirt, and soaked bed sheets, all of which were changed; the CNA then placed two incontinence briefs on the resident. The CNA stated he typically placed two briefs on this resident, although the care plan did not direct staff to use two briefs, and the Executive Director later confirmed staff should not place two briefs on a resident unless care planned. Documentation for the relevant dates did not show any refusals of care in the point-of-care records or progress notes, despite staff statements that the resident had not refused care.
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