Failure to Maintain Resident Dignity and Address Needs During Care and Call Light Response
Penalty
Summary
Certified Nursing Assistants (CNAs) on the night shift failed to maintain the dignity of a resident with functional quadriplegia and multiple pressure ulcers by leaving the resident uncovered and with their gown up when they left to assist another resident. This occurred while the resident was dependent on staff for all activities of daily living, including bed mobility and transfers, and had intact cognitive skills. The resident reported feeling upset and neglected when left in this vulnerable state, as the CNAs did not focus on their care during these incidents. In a separate incident, staff failed to address the needs of a resident with diabetes, dysphagia, and an indwelling urinary catheter when responding to a call light in a shared room. Both a male staff member and a CNA only inquired about the needs of the roommate and did not check on the resident, despite the resident's repeated use of the call light. The resident expressed feeling bad about being overlooked, and the CNA later acknowledged that both residents in a shared room should be asked if they need assistance when a call light is activated.