Failure to Implement Individualized Toileting Program for Incontinent Resident
Penalty
Summary
The deficiency involves the facility’s failure to identify, assess, and implement an individualized toileting program to maintain or improve bladder continence for a resident with urinary incontinence and multiple comorbidities. On admission, the resident’s MDS documented moderately impaired cognition, a history of stroke, chronic systolic and diastolic heart failure, muscle weakness, unsteadiness on feet, fatigue, gait and mobility abnormalities, and a cognitive communication deficit. The resident required partial to moderate assistance with toileting hygiene and dressing, used a walker and wheelchair, and had occasional urinary incontinence while remaining continent of bowel. Despite these findings and the resident’s use of diuretics, no trial of a toileting program such as scheduled toileting, prompted voiding, or bladder training was initiated on admission. The record lacked a comprehensive bowel and bladder assessment, and the CAA identified frequent urinary incontinence with modifiable factors but did not specify the type of incontinence or translate these findings into specific toileting interventions. The resident’s care plan identified a self-care deficit related to congestive heart failure and noted the need for one-person assistance with ambulation, dressing, hygiene, bed mobility, and toileting, as well as frequent bladder incontinence, but it did not address urinary incontinence with individualized interventions or a toileting program. Bladder records showed a mix of continent and incontinent episodes over several weeks. Observation and interview revealed the resident ambulated to the bathroom independently without using the call light, sometimes forgetting to use the walker and experiencing incontinence when trying to reach the bathroom, and reported not receiving staff assistance with toileting. A nursing assistant confirmed staff expected the resident to use the call light and did not routinely check or offer toileting assistance. The RN and DON both acknowledged that comprehensive bowel and bladder assessments, including three-day assessments, were not completed to develop individualized toileting plans, and that although the resident was frequently incontinent, no individualized toileting interventions were in place, contrary to the facility’s urinary incontinence policy requiring comprehensive assessment and individualized toileting programs.
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