Scheduled Toileting Program Compliance Log

Inspection template for documenting hourly toileting rounds, resident response, and missed opportunities for residents enrolled in a continence improvement program. Supports restorative nursing documentation and MDS Section H coding review.

Inspection Details

• Resident identified and toileting program order verified
  Confirm the resident is the correct individual and that the scheduled toileting program is active in the care plan or order set.
• Inspection date and shift recorded
  Record the date and time of the compliance check.
• Inspector name and role recorded
  Document the staff member completing the inspection.
• Program type documented
  Identify the continence improvement program being audited.

Scheduled Round Compliance

• Toileting round completed at scheduled interval
  Verify the resident was offered toileting at the ordered interval, such as hourly or per care plan.
• Round time documented accurately
  Check that the actual time of the toileting offer or assistance is recorded clearly and legibly.
• Resident response documented
  Record the resident's response to the toileting offer.
• Missed opportunity escalated and documented
  If a round was missed, late, or declined repeatedly, verify escalation to the nurse and documentation in the chart.
• Pattern of refusals reviewed for intervention
  Confirm repeated refusals are being trended and addressed with care plan interventions.

Resident Safety and Dignity

• Privacy maintained during toileting assistance
  Verify privacy measures were used, such as closing the door or curtain and limiting unnecessary exposure.
• Safe transfer or ambulation assistance provided as needed
  Confirm assistance matched the resident's mobility status and fall risk precautions.
• PPE used appropriately for hygiene and infection prevention
  Check that gloves and other PPE were used according to task and exposure risk.
• Call light, bedside items, and resident comfort restored after care
  Verify the resident was left in a safe, comfortable, and accessible condition after toileting care.
• Skin integrity concerns observed or reported
  Note any redness, moisture-associated skin damage, or other skin concerns related to incontinence.

Documentation Quality

• Charting is complete, legible, and timely
  Verify documentation was entered promptly and can be read and understood by other caregivers.
• Assistance level documented
  Confirm the record shows the level of assistance provided, such as independent, standby, one assist, or two assist.
• Incontinence episode, if present, documented accurately
  If the resident was incontinent, verify the episode, care provided, and any supplies used were documented.
• Care plan or restorative notes updated when needed
  Confirm changes in continence status, refusals, or new barriers were communicated for care plan review.

Corrective Action and Sign-Off

• Deficiencies documented with corrective action
  Summarize any non-conformance, missed round, refusal trend, or documentation gap and the corrective action taken.
• Follow-up owner assigned
  Identify the staff role responsible for follow-up, such as charge nurse, restorative nurse, or CNA supervisor.
• Follow-up due date recorded
  Enter the date and time by which corrective action or recheck should be completed.
• Inspector signature
  Signature confirming the inspection findings and documentation review.