Failure to Honor Resident Choice in Morning Routines
Penalty
Summary
The facility failed to honor the rights of several residents to make choices about their daily routines, specifically regarding their preferred wake-up and get-up times. Observations and interviews revealed that multiple residents were awakened, dressed, and brought to common areas significantly earlier than their stated preferences, with some residents expressing distress or dissatisfaction about being up too early. Staff interviews confirmed the existence of a 'get-up list' or 'early riser list' that directed CNAs to get specific residents up in the early morning hours, regardless of individual preferences, unless a resident was adamant in refusing. Resident records and care plans indicated that residents should be offered the choice to get up in the morning and allowed to refuse, with encouragement for out-of-bed activities aligned with their preferences. Despite these documented directives, residents with varying levels of cognitive impairment and physical assistance needs were observed awake, dressed, and in wheelchairs or specialized chairs in their rooms or dining areas before their preferred times. Several residents directly stated they were not asked about their preferences or were upset about being awakened early, and staff acknowledged following a list rather than individualized routines. The facility's policy on resident rights emphasizes dignity, respect, and self-determination, including support for residents' choices regarding their daily routines. However, the practice of using a predetermined list to manage morning routines resulted in residents being awakened and dressed earlier than they desired, contrary to their care plans and stated preferences. This practice was confirmed through staff interviews and documentation, demonstrating a failure to fully support residents' rights to self-determination and a dignified existence.