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F0550
D

Failure to Maintain Resident Dignity During Meal Service

Lancaster, Pennsylvania Survey Completed on 04-11-2025

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

A deficiency was identified when a staff member failed to maintain a resident's dignity during a meal. Resident 51, who had a moderate cognitive impairment and a diagnosis of traumatic brain injury, was observed sitting in a recliner in the hallway outside their room. During this time, a non-licensed employee, while distributing breakfast trays, interrupted a conversation between the resident and a surveyor and stated that the resident was about to have breakfast. Instead of properly setting up the resident for the meal, the employee opened the resident's breakfast tray while it was still on the food cart, used bare hands to pick up half a piece of French toast, and handed it directly to the resident. The resident then began eating the food placed in their hand by the staff member, while the employee continued to distribute trays to other residents. This incident demonstrated a failure to ensure the resident's dignity was maintained during the breakfast meal service.

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