§483.25(e) Incontinence. §483.25(e)(1) The facility must ensure that resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain.
§483.25(e)(2)For a resident with urinary incontinence, based on the resident's comprehensive assessment, the facility must ensure that- (i) A resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization was necessary; (ii) A resident who enters the facility with an indwelling catheter or subsequently receives one is assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catheterization is necessary; and (iii) A resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible.
§483.25(e)(3) For a resident with fecal incontinence, based on the resident's comprehensive assessment, the facility must ensure that a resident who is incontinent of bowel receives appropriate treatment and services to restore as much normal bowel function as possible.
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Observations:
Based on observations, review of clinical records and facility documentation, and interviews with residents and staff, it was determined that the facility failed to provide proper continence care for one of one resident reviewed (Resident 70).
Findings include:
Review of Resident 70's Quarterly MDS (Minimum Data Set - a mandatory periodic resident assessment tool), dated January 19, 2024, revealed that the resident was admitted to the facility on September 24, 2021, and had diagnoses including Encounter for attention to gastrostomy (tube feed- artificial external opening into the stomach for nutritional support or gastric decompression), Scoliosis (sideways curvature of the spine or back bone), Intellectual disability (a condition that limits intelligence and disrupts abilities necessary for living independently). Continued review revealed that the resident was dependent for toileting hygiene. Further review revealed that the resident was always incontinent of bowel and bladder.
Review of Resident 70's care plan revealed the following intervention for potential for constipation: "Bowel meds as ordered" and "Following facility bowel protocol for episode of constipation" with a date initiated of April 20, 2022.
Further review of Resident 70's clinical medical record revealed an order for "Milk of Magnesia (used to treat occasional constipation) 400MG/5ML, Give 30 ml orally as needed for Constipation ON 3-11 SHIFT IF NO BOWEL MOVEMENT BY THE EVENING OF 3RD DAY."
Review of Resident 70's bowel function (task used to track bowel movement) from January 17, 2024, through February 14, 2024, revealed Resident 70 did not have a bowel movement on the following days:
January 18, 2024, January 19, 2024, January 20, 2024 January 22, 2024, January 23, 2024, January 24, 2024 February 1, 2024, February 2, 2024, February 3, 2024 February 5, 2024, February 6, 2024, February 7, 2024
Review of Resident 70's eMAR (electronic medication administration record) revealed the facility did not administer Milk of Magnesia on the evenings of January 20, 2024, January 24, 2024, February 3, 2024, or February 7, 2024.
Interview conducted with the Director of Nursing (DON) on February 15, 2024, at 1:15 p.m. confirmed Resident 70 did not receive Milk of Magnesia on the dates listed above.
28 Pa Code 201.14(a) Responsibility of licensee
28 Pa Code 211.12(d)(5) Nursing services
| | Plan of Correction - To be completed: 03/15/2024
Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required.
1.Resident R70 was reassessed, and no concerns were noted related to the facilities alleged deficient practice.
2.An audit of current residents was conducted by the DON/Designee to ensure that bowel protocols were present and being followed as ordered.
3.DON/Designee will educate licensed staff on the components of this regulation with an emphasis on ensuring that bowel protocols are present and being implemented if required.
4.DON/Designee will audit bowel movements of 5 residents weekly x 4 weeks, and monthly for 6 months to ensure bowel protocol was initiated per orders. The findings of these quality monitoring's to be reported to the Quality Assurance/Performance Improvement Committee monthly and/or until substantial compliance is met. Quality Monitoring schedule modified based on findings with quarterly monitoring by the Regional Director of Clinical Services / Designee.
5.Date of Compliance will be 3/15/2024.
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