Failure to Maintain Resident Dignity and Timely Assistance with Meals
Penalty
Summary
Surveyors identified that staff failed to maintain resident dignity and timely care in several instances. One resident with intact cognition and a history of stroke, hemiplegia, and COPD was observed wearing a shirt stained with food after breakfast. The resident expressed discomfort about being in public with the stained shirt and stated she would have preferred to have it changed. Staff acknowledged the stain but did not change the shirt after transferring the resident to bed, and the resident remained in the stained shirt for an extended period. Additionally, when the resident requested to go outside to smoke, a staff member responded abruptly and dismissively, which made the resident feel insignificant. Another resident, also with intact cognition and diagnosed with multiple sclerosis and quadriplegia, required maximal assistance for eating. This resident routinely experienced delays in receiving assistance with meals, often being the last to be served because staff were not available to help her eat when she arrived in the dining room. The resident reported feeling neglected and believed staff prioritized other residents over her, particularly after the departure of a staff member who previously assisted her regularly. The issue was corroborated by interviews with dietary and clinical staff, who confirmed that the resident's meal was withheld until a staff member was available to assist, resulting in frequent delays. Facility records and staff interviews confirmed that both residents' concerns had been raised to management, and the issues persisted despite awareness among leadership. The facility's own policy emphasized the importance of maintaining resident dignity and providing necessary assistance, but observations and interviews demonstrated that these standards were not consistently upheld for the affected residents.