Failure to Provide Prescribed Adaptive Eating Equipment
Penalty
Summary
A deficiency occurred when a resident with dysphagia, who had a physician order for a nosey cup to be provided with meals, did not consistently receive this adaptive equipment with their meal trays. During a lunch meal observation, the resident was given a regular plastic cup instead of the prescribed nosey cup, resulting in liquid spilling from the resident's mouth while drinking. Staff interviews confirmed that the nosey cup was not always provided with the resident's meal trays, despite clear documentation on the tray card and physician orders specifying its necessity. Multiple staff members, including certified nursing assistants, dietary staff, registered dietitians, and therapists, acknowledged that the nosey cup was essential for the resident's ability to drink liquids safely and comfortably. The facility's policy required that adaptive self-feeding devices be provided to residents who need them with each meal or snack, but this was not consistently followed for the resident in question. The failure to provide the prescribed adaptive equipment was directly observed and confirmed by staff interviews.