Neglect of ADL and Toileting Care by CNA Resulting in Incontinence-Related Harm
Penalty
Summary
The deficiency involves a CNA’s failure to provide required ADL care and toileting assistance to two dependent residents during a night shift, resulting in neglect. On the night in question, an LPN observed that the traveling CNA repeatedly refused to answer residents’ call lights, spent time on her cell phone, and did not toilet residents or change their incontinence products. When one resident activated her call light, the CNA entered the room, turned off the call light, and left without assisting the resident. Shortly afterward, the call light was activated again, and the LPN responded, finding that the resident needed to use the bathroom and reported that the CNA would not help her. The LPN, with an RN, then assisted the resident to the toilet, provided hygiene care, and returned her to bed. The first resident involved had multiple medical conditions, including arthritis, a history of hip fracture, a chronic non‑pressure ulcer of the right lower leg, a bone density disorder, and mild dementia, with a BIMS score indicating moderately impaired cognition. Her care plan required total assistance with ADLs, dependence on staff for all transfers using a Hoyer lift, staff assistance with toileting or bedpan use, hygiene assistance as needed, and turning and repositioning every one to two hours while in bed. Despite these documented needs, the CNA did not provide the required toileting and hygiene assistance when the resident requested help via the call light, and the resident’s needs were only met when the LPN and RN intervened. The second resident involved also had significant medical and functional limitations, including obesity, arthritis, muscle weakness, encephalopathy, a history of traumatic brain injury, a left lower leg contracture, and mild dementia. His care plan indicated a self‑care deficit related to his traumatic brain injury and contracture, and required extensive assistance from two staff with a sit‑to‑stand lift, as well as two‑person assistance with toileting and hygiene. Staff were to assist him with toileting upon waking, before and after meals, at bedtime, and during night rounds. However, during the same night shift, the CNA failed to complete resident rounds or provide toileting and incontinence care. Subsequent checks revealed that both residents had heavily saturated incontinence products and urine‑soaked beds, and the second resident had redness and moisture‑associated skin damage in the buttock area, demonstrating that his scheduled toileting and hygiene interventions were not carried out as planned.
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