Other·May 31, 2024

Code of Federal Regulations, Title 42, §483.10(a) Resident Rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. §483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident’s individuality. The facility must protect and promote the rights of the resident. §483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source. §483.10(b) Exercise of Rights. The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States. §483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility. §483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart. California Code of Regulations, Title 22, Section 72433. Social Work Service Unit - Services. California Code of Regulations, Title 22, Section 72527. Patients' Rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (12) To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care of personal needs. California Code of Regulations, Title 22, Section 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. On 4/17/2024, the California Department of Public Health (CDPH) conducted an unannounced visit at the facility to investigate a complaint regarding resident rights and quality of care. As a result of the investigation, the CDPH determined the facility failed to provide Resident 1 with dignity and respect in accordance with the facility's policy and procedure (P&P) titled, "Resident Rights," by failing to ensure Certified Nursing Assistant (CNA) 1 and CNA 2 provided Resident 1 with alternative methods to go to the bathroom and assisted Resident 1 with the resident's toileting needs. CNA 1 and CNA 2 told Resident 1 to void (urinate) in Resident 1's incontinence brief (brief used to capture urine) for CNA 1 and/or CNA 2 to change after voiding. This failure violated Resident 1’s right to be treated with dignity and respect and caused Resident 1 to have feelings of depression and burden. A review of Resident 1's Admission Record indicated, the facility admitted Resident 1, a 78-year-old female, to the facility on 6/15/2022, with diagnoses of functional quadriplegia (a condition where all four limbs experience paralysis [inability to move]) and abnormalities of gait and other mobility. A review of Resident 1's untitled care plan (CP) initiated on 6/29/2022, indicated Resident 1 was continent (able to control) of bowel and bladder function and able to verbalize the need for assistance. The CP interventions indicated for staff to assist Resident 1 with toileting. A review of Resident 1's Minimum Data Set (MDS- a standardized resident assessment and care screening tool), dated 3/22/2024, indicated Resident 1 had moderate cognitive impairment. The MDS indicated Resident 1 was dependent on the staff for toileting hygiene. The MDS indicated Resident 1 required substantial/maximal assistance from the staff with rolling left and right, sitting to lying, lying to sitting on side of bed, and chair/bed-to-chair transfers. The MDS indicated sitting to standing and walking were not attempted due to Resident 1’s medical condition or safety concerns. The MDS indicated Resident 1 was occasionally incontinent of bladder. The MDS indicated Resident 1 was not on a trial or current toileting program (scheduled toileting, prompted voiding, or bladder training) to manage Resident 1's urinary incontinence. During an interview on 4/17/2024 at 10:01 am with Resident 1, Resident 1 stated Resident 1 had to "go to the bathroom" in her "diaper" because Resident 1 required a Hoyer lift (mobility tool used to transfer residents with minimum physical effort) to move. Resident 1 stated staff would tell Resident 1 to go (urinate) in her brief and staff would change Resident 1 after. Resident 1 stated Resident 1 did not like to urinate in the brief because Resident 1 was not incontinent. Resident 1 stated staff had not provided Resident 1 with an alternative method of going to the restroom that did not involve Resident 1 soiling Resident 1's self before being changed. Resident 1 stated staff told Resident 1 that it was too difficult to get Resident 1 out of bed to urinate in a toilet. Resident 1 stated Resident 1 felt trapped in bed. Resident 1 stated Resident 1 felt like a burden to staff. Resident 1 stated staff making Resident 1 go to the bathroom in the brief, made Resident 1 "feel like an animal" and she did not matter. Resident 1 stated Resident 1 felt depressed about it. During an interview and record review on 4/17/2024 at 11:13 am, Certified Nurse Assistant (CNA) 1 stated Resident 1's continence status did not change. CNA 1 stated Resident 1 was incontinent of urine because CNA 1 always changed Resident 1's brief after Resident 1 urinated in her brief. CNA 1 stated she did not offer Resident 1 to use a bed pan or be transferred to a toilet before urinating in Resident 1's brief. CNA 1 stated CNA 1 told Resident 1 to go (urinate) in her brief and CNA 1 would change Resident 1's brief after. CNA 1 stated it was difficult to use the Hoyer lift to move Resident 1. CNA 1 stated it could make Resident 1 feel better if Resident 1 was assisted with a bed pan because it could help improve Resident 1's independence and continence status. During an interview on 4/17/2024 at 11:24 am, CNA 2 stated while Resident 1 was continent of urine, Resident 1 urinated in the brief because it was "too hard" to assist Resident 1 with going to the bathroom. CNA 2 stated it was "standard" for Resident 1 to urinate in her brief and then ask to be changed. CNA 2 stated CNA 2 had not offered Resident 1 to use a bed pan before urinating in her brief. CNA 2 stated if a resident had mobility issues but was continent, CNA 2 could offer a bed pan. CNA 2 stated it was important to offer alternatives for the resident to go to the bathroom in a brief because it could help the resident build strength, independence, and stop the resident from being soaked in his/her own urine until staff was available to assist. CNA 2 stated making Resident 1 urinate in her brief instead of assisting Resident 1 with a bed pan could make Resident 1 feed bad and frustrated. During an interview on 4/17/2024 at 11:54 am, Licensed Vocational Nurse (LVN) 1 stated having mobility issues and/or being “bedbound” did not mean Resident 1 was incontinent. LVN 1 stated Resident 1 was continent "most of the time." LVN 1 stated Resident 1 could control when Resident 1 needed to urinate and needed to be offered a bed pan every time Resident 1 needed to use the bathroom. LVN 1 stated if other staff (CNAs) did not know Resident 1 was only occasionally incontinent and were not offering toileting assistance with a bed pan, Resident 1 would not know that option was available as an alternative. LVN 1 stated telling Resident 1 to go in her brief instead of offering a bed pan could weaken Resident 1's bladder, worsen incontinence, and was a dignity issue. LVN 1 stated Resident 1 should not urinate in Resident 1's brief if Resident 1 had the ability to control her bladder occasionally. During a concurrent interview and record review on 4/17/2024 at 2:38 pm, the MDS Coordinator (MDSC) reviewed Resident 1's MDS dated 3/22/2024. The MDSC stated the facility assessed Resident 1 as occasionally incontinent according to what the CNAs documented in Resident 1's chart. The MDSC stated being occasionally incontinent meant Resident 1 had more periods of continence than incontinence. The MDSC stated Resident 1 had control over her bladder most of the time. The MDSC stated Resident 1 needed assistance with toileting to maintain and potentially improve Resident 1's continence status according to Resident 1’s MDS. The MDSC stated if staff were providing Resident 1 toileting assistance, it could give Resident 1 more independence, prevent skin breakdown and infection, and allow Resident 1 to maintain as much continence as possible. The MDSC stated Resident 1 would benefit from a toileting schedule to assess what times of the day Resident 1 generally went to the bathroom so the staff could create a schedule based off Resident 1's toileting pattern. The MDSC stated staff could then offer toileting assistance with a bed pan at those times to help Resident 1 maintain, if not improve Resident 1's continence status. The MDSC stated making Resident 1 go in her brief instead of assisting the resident to use a bed pan was a dignity issue. During an interview on 4/17/2024 at 3:45 pm, the Director of Nursing (DON) stated residents with occasional incontinence were more often continent than incontinent. The DON stated a resident with occasional incontinence like Resident 1 should be offered toileting assistance to help maintain his/her level of continence or improve it, promote independence, and decrease the risk for infections and falls. The DON stated Resident 1 being told to urinate in the brief before being changed was not an accurate portrayal or assessment of Resident 1's continence status. The DON stated this could contribute to incontinence and cause Resident 1 to feel helpless, not cared for, depressed, embarrassed, and affecting Resident 1 mentally. The DON stated Resident 1 needed to be offered a bed pan every time Resident 1 felt the urge to go to the bathroom. The DON stated it was not acceptable for staff to tell Resident 1 to go to the bathroom in their briefs because residents must be assisted with toileting as much as possible to maintain or improve the resident’s continence status. The DON stated making Resident 1 urinate in the brief forced Resident 1 to be incontinent and did not give an accurate assessment of Resident 1's care needs, level of assistance, and continence status. A review of the facility's P&P titled, "Resident Rights," revised on 12/19/2022, indicated the facility ensured that all direct care and indirect care staff members, including contractors and volunteers, were educated on the rights of resident and the responsibility of the facility to properly care for its residents. The P&P indicated resident had the right to be treated with dignity and respect, including the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences. The P&P indicated residents had the right to make choices about aspects of his or her life in the facility that were significant to the resident. The facility failed to provide Resident 1 with dignity and respect in accordance with the facility's P&P titled, "Resident Rights," by failing to ensure CNA 1 and CNA 2 provided Resident 1 with alternative methods to go to the bathroom and assisted Resident 1 with the resident's toileting needs. CNA 1 and CNA 2 told Resident 1 to void in Resident 1's incontinence brief for CNA 1 and/or CNA 2 to change after voiding. This failure violated Resident 1’s right to be treated with dignity and respect and caused Resident 1 to have feelings of depression and burden. This violation, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Resident 1.