Resident Not Served Meal with Peers, Dignity Compromised
Penalty
Summary
A deficiency occurred when a resident was not served lunch at the same time as other residents at her table. On the observed date, the resident, who was seated in a wheelchair with two other residents in the dining room, was not provided her meal while the others were served and began eating. The resident was seen waiting and inquired about her food, eventually receiving her meal approximately 30 minutes after the others. Staff interviews confirmed that the resident's meal tray had been mistakenly placed on a different cart and was intended for room service, resulting in the delay. Both the Activity Director and Licensed Vocational Nurse acknowledged that meals should be served in an organized manner to ensure no resident is left out, and that this incident was a dignity issue. The resident involved had a history of depression and diabetes mellitus and was documented as mentally capable of understanding her surroundings. The Director of Nursing stated that staff are expected to serve trays simultaneously to all residents at a table and follow a system to prevent such oversights. The facility's policy on dignity and privacy requires all residents to be treated with kindness, dignity, and respect. The failure to serve the meal in a timely and equitable manner led to the resident feeling forgotten and potentially affected her psychosocial well-being.