Failure to Provide Timely Incontinence Care and Toileting Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary assistance with activities of daily living, specifically toileting hygiene and incontinence care, to a cognitively impaired resident who was fully dependent on staff for these needs. The resident was an elderly female with diagnoses including cerebral infarction, cognitive communication deficit, lack of coordination, overactive bladder, and dementia, and her quarterly MDS showed a BIMS score of 07, indicating severe cognitive impairment. Her care plan documented bowel and bladder incontinence, with goals to prevent complications and maintain function, and interventions that included checking her every two hours, assisting with toileting as needed, and providing frequent incontinence care with moisture barrier application. On the date in question, documentation of toileting hygiene and incontinence care tasks reflected that the resident received incontinence care at 12:17 AM and again at 8:56 PM, with no care recorded for the day shift between 6 AM and 2 PM. Observations showed the resident seated in the living room eating breakfast at 9:15 AM and later participating in activities and receiving lunch, remaining in the same clothing throughout the morning and early afternoon. During an interview in the late morning, the resident stated that her brief had not been changed since she got out of bed, though she could not specify the time. Review of automated electronic surveillance video for that day showed that the resident’s room camera did not activate between 9:10 AM and 3:30 PM, with activation only when she was brought back to her room and provided incontinence care at 3:30 PM. The family member reported monitoring the video and stated they did not see the resident return to her room for incontinence care until that time, and that they had to call the nurse’s station to request care. Facility staff, including an RN, a CNA, the DON, and the ADM, all stated that residents should be checked and changed every two to three hours, and the facility’s perineal care policy required incontinent residents to be checked and changed as needed based on an appropriate schedule. Despite these expectations and policies, the resident was not checked or provided incontinence care for approximately six hours during the day.
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