Failure to Honor Resident's Meal Location Preference
Penalty
Summary
The facility failed to honor a resident's expressed preference to eat meals in his room rather than in the dining room. During a wound care observation, the resident stated he would rather eat in his room, but staff required him to eat in the dining room for all meals. The Assistant Director of Nursing acknowledged the resident's preference but did not accommodate it. The resident was cognitively intact, able to feed himself with some assistance, and receiving hospice care. His care plan included interventions to offer him choices and assist with meal setup as needed. The clinical record and interviews revealed that the resident had a history of anxiety, depression, and physical limitations, but no upper extremity impairment. A speech therapy summary recommended close supervision during meals and upright posture, but did not specify a requirement for dining room meals. The resident's diet was changed from pureed to regular with thin liquids at his request, after being educated about aspiration risks. Despite understanding the risks, the resident consistently expressed his desire to eat in his room, which was supported by his spouse and documented by the hospice nurse case manager. Staff interviews indicated that it was facility policy for residents requiring assistance to eat in the dining room, citing safety concerns. The Director of Nursing and Administrator both stated that the resident was encouraged or required to eat in the dining room, and noted his resistance, especially when family was present. Meal intake records showed the resident frequently refused meals, particularly breakfast, due to not wanting to go to the dining room. The facility's own policy emphasized residents' rights to self-determination and choice, but these were not honored in this case.