Failure to Provide Timely Incontinent Care and ADL Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide timely incontinent care and assistance with activities of daily living (ADLs) to a resident who was dependent on staff for toileting and hygiene. The resident was an older female with multiple diagnoses, including COPD, dementia with mood disturbance, type 2 diabetes, morbid obesity, chronic kidney disease, overactive bladder, and bowel and bladder incontinence. Her MDS assessment showed moderate cognitive impairment, substantial assistance needs for most ADLs, wheelchair use, and dependence on all mobility tasks. Her care plan identified bowel/bladder incontinence related to decreased mobility, deconditioning, activity intolerance, weakness, unsteady gait, and impaired cognition, with interventions that included use of disposable briefs, checking for incontinence as required, washing and drying the perineum, changing clothing as needed after incontinence episodes, monitoring for UTI, and observing the peri-area for redness or excoriation. On the day of the incident, the resident used her call light to request assistance with changing her clothes and a soiled brief. A CNA responded, and the resident requested to be changed. The CNA reported that when she checked the resident’s closet, only smaller briefs were available and not the XXXL size the resident preferred, so she went to a storage area on another hall to obtain the correct size. The CNA stated that when she returned to the resident’s room, the resident was asleep, and the CNA decided not to wake her and did not change the soiled brief at that time. The CNA acknowledged that she made the decision not to change the resident and that the expectation was to wake the resident to change her if requested. The resident and her responsible party reported that the resident remained in a soiled brief for several hours despite repeated attempts to obtain assistance. The responsible party stated she received a call from the resident crying and reporting she had been waiting since early morning for her soiled brief to be changed. The responsible party described multiple unsuccessful attempts to reach facility staff by phone and reported that, during follow-up calls with the resident over the next several hours, the resident stated she still had not been changed and had fallen asleep while waiting. The resident later stated that staff told her they had not changed her because she was asleep when they returned, and she expressed confusion and upset because staff routinely woke her for other reasons and she wanted to be awakened to be changed. The facility’s policies on Quality of Care and Resident Rights required that residents unable to perform ADLs receive necessary services for toileting and hygiene and that residents be treated with dignity and be appropriately groomed and in clean clothing.
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