Failure to Honor Resident’s Right to Toileting Assistance During Meals
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to toileting assistance during meal periods. During an interview, Resident #74 reported that CNAs told her she would have to wait to be toileted until staff finished feeding other residents, and that aides did not want to toilet her during meal times. The resident’s care plan documented that she required assist of two staff with most ADLs, including toileting and transfers with a mechanical lift, had frequent bladder incontinence and occasional bowel incontinence, used a bedpan, and did not ambulate. Multiple progress notes in the medical record described ongoing issues with toileting during tray pass and feeding times, including the resident’s dissatisfaction and statements that she could not control when she needed to use the bathroom. Progress notes by Social Worker #83 and the Social Services Director documented that the ADON and SW met with the resident to discuss a plan for her to use the bathroom at the start of meals, and that the resident was informed staff were not able to stop passing trays and feeding to toilet her. Staff reported that the resident was unhappy, felt she had no privacy, and complained that staff “went and told on” her for wanting to be changed during meals. Another note indicated that when the resident requested to be changed during tray pass, a CNA told her it would be a little while because staff were passing out trays, and the resident then demanded to be changed immediately or she would not eat. In interviews, the SW stated the facility tried to toilet residents before meals, and the ADON stated that if staff were feeding someone, a resident using the call bell for toileting during meal pass would have to wait until feeding was finished before staff responded. The interpretive guidance cited in the report specifically identifies refusing to comply with a resident’s request for bathroom assistance during meal times as a demeaning practice, and the report notes that this practice has the potential to impact a resident’s psychosocial and physical well-being.
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