Failure to Provide Timely Incontinence and ADL Care
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary ADL and incontinence care to residents who were unable to perform these tasks independently, resulting in unmet needs for nutrition, grooming, and personal and oral hygiene. One resident with Type 2 diabetes, Parkinson’s disease, dementia, and bowel and bladder incontinence had a care plan requiring frequent incontinence care, application of moisture barrier after each episode, and checks every two hours with toileting assistance as needed. The resident reported being left in wet briefs for hours, waking early in the morning and not being checked until mid-morning. On observation, the resident was found visibly soiled with urine and feces when CNAs provided incontinence care nearly three hours after the CNA’s shift began. The CNA acknowledged not checking on the resident until that time and stated she relied on the resident to notify staff when wet or soiled, despite the resident’s documented incontinence and cognitive impairment. Another resident with a right humerus fracture, Type 2 diabetes, weakness, disorientation, and frequent bowel and bladder incontinence had an MDS indicating intact cognition and a need for supervision with eating and oral hygiene, and substantial assistance with other ADLs. The resident’s care plan included assistance with personal hygiene, bathing, and toileting. Responsible parties for this resident reported multiple episodes of delayed response to call lights for toileting and incontinence needs, including one instance where they waited 25 minutes after activating the call light, then an additional 6 minutes after notifying the nurse’s station, during which the resident experienced an incontinence episode. Another responsible party reported timing a 25-minute period with no staff response and ultimately assisting the resident to the restroom personally, and described similar incidents without specific details. A LVN stated she expected CNAs to round at least every two hours and assist with incontinence care but did not routinely supervise CNAs, stating it was not her job, while the DON and ADM both stated expectations that CNAs round every two hours and provide incontinence care as needed. The facility’s perineal care policy required incontinent residents to be identified, assessed, and provided appropriate treatment and services.
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