Failure to Provide ADL Assistance During Meals for Residents with Cognitive Impairment
Penalty
Summary
The facility failed to recognize and assess the inability of two residents to perform Activities of Daily Living (ADLs), specifically related to eating, and did not implement appropriate interventions according to their assessed needs. Both residents had cognitive impairments, including dementia and severe cognitive deficits, and were identified as being at nutritional risk. Care plans for both residents indicated the need for supervision, set-up assistance, and cuing during meals, as well as adherence to standard ADL and nutrition protocols. Despite these documented needs, observations revealed that staff did not provide adequate assistance or encouragement during mealtimes. One resident was repeatedly observed struggling to eat independently, using her fingers to pick up food from the table, and consuming less than 25% of her meals without staff intervention. Staff members, including RNs, LPNs, and CNAs, were present but did not offer the necessary assistance, such as moving the resident closer to the table, providing encouragement, or helping with feeding. Similar issues were observed with the second resident, who did not attempt to eat and was not provided with timely or effective assistance, despite staff being aware of her needs for set-up and cuing. Interviews with staff confirmed that they relied on the care plan or Kardex to determine the level of assistance required but did not consistently act when residents were observed not eating or having difficulty. The lack of proactive assessment and intervention resulted in both residents not receiving the care and assistance needed to perform ADLs, specifically eating, as outlined in their care plans and facility protocols.