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F0550
E

Failure to Maintain Resident Dignity During Mealtime Assistance

El Monte, California Survey Completed on 04-04-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Certified Nursing Assistants (CNAs) failed to treat two residents with dignity during mealtime assistance. For one resident with Parkinson's disease, dementia, and severely impaired cognitive skills, a CNA was observed feeding the resident while standing over the bed, with the resident's head at the CNA's waist level. The resident was in a high Fowler's position and required assistance with meals as documented in the care plan. Facility staff, including another CNA and the Director of Nursing (DON), confirmed that proper feeding technique requires staff to be seated at eye level with the resident to ensure comfort and engagement. Facility policy also specifies that feeding should be conducted in a patient, respectful, and dignified manner. A second resident, diagnosed with dementia, hemiplegia, and hemiparesis, was also observed being fed by a CNA who was standing at the bedside. This resident had severely impaired cognition and required partial to full assistance with eating and other activities of daily living. Interviews with staff and review of facility policy confirmed that staff should sit at eye level with residents during feeding to promote engagement and maintain a calm, pleasant dining environment. The observed actions were inconsistent with both facility policy and staff training, resulting in a failure to honor the residents' right to dignity during mealtime.

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