Failure to Maintain Resident Dignity During Incontinent Care
Penalty
Summary
The deficiency involves the facility’s failure to protect two residents’ dignity during incontinent care and bowel movement cleanup. Resident 1, who had diagnoses including cerebral infarction, seizures, left-sided hemiplegia, and brain compression, was assessed as dependent on staff for toileting, showering, personal and oral hygiene, and dressing, and was always incontinent of urine and bowel. The resident’s H&P indicated he did not have capacity to understand and make decisions. During an interview, Resident 1 reported that CNA 1 wiped him hard after a bowel movement, stated that CNA 1 was “digging in his rectum,” and said he told CNA 1 to stop and to get out of his room, but CNA 1 laughed at him. Resident 1 stated he felt violated, upset, mad, and expressed wanting to kill CNA 1. Resident 1’s responsible party later reported to LVN 1 that CNA 1 was digging too deep in the anal area and did not stop when Resident 1 said stop. Resident 2 had diagnoses including generalized muscle weakness, lack of coordination, difficulty walking, and end-stage renal disease, and was documented as having fluctuating capacity to understand and make decisions. The MDS indicated Resident 2 could express ideas and wants, required substantial to maximal assistance with toileting, showering, and dressing, and was frequently incontinent of urine and always incontinent of bowel. Resident 2 reported that CNA 2 wiped him with force and placed two fingers in his rectum in the shower, stating this occurred four times during cleaning. Resident 2 stated he felt humiliated and was afraid CNA 2 would find out his personal information and where he lives. CNA 1 acknowledged being assigned to Resident 1 on two days and stated Resident 1 accused him of inserting his fingers in the resident’s rectum. CNA 2 acknowledged being assigned to Resident 2 on a day when the resident had a bowel movement, and described placing the bed flat, removing the diaper, and using wipes to clean the perineal area while Resident 2 was tense and instructed to relax. The DON stated that a family member of Resident 2 reported CNA 2 was rough and put two fingers in Resident 2’s rectum. The DON also described that proper handling and cleaning require explaining to residents before touching them, asking if they are comfortable, and stopping and calling the charge nurse if a resident is uncomfortable and says stop. Facility policies on Quality of Life – Dignity and Resident Rights required that residents be treated with dignity, respect, kindness, and in a manner that promotes and enhances self-esteem and self-worth, which was not followed in these incidents.
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