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F0550
D

Failure to Maintain Resident Dignity and Timely Assistance During Meals

Brewster, New York Survey Completed on 04-23-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain residents' dignity and provide timely assistance with eating during meal services on the Apple unit. Due to an outbreak of respiratory syncytial virus, the unit dining room was closed, and residents were served meals in the hallways. Observations revealed that residents waited extended periods for assistance with eating because of a shortage of tray tables and insufficient staff. For example, one resident who was dependent for eating waited approximately 25 minutes before being assisted, while another resident with severe cognitive impairment and requiring supervision or assistance was left with an uneaten tray for over an hour before receiving minimal help. Another resident requiring setup assistance had their tray delivered but not set up for nearly an hour. Staff interviews confirmed that the dining room closure led to meals being served in hallways for supervision purposes, not infection control. The unit was short-staffed, with only two CNAs present instead of the minimum three, resulting in residents waiting a long time for assistance. Staff, including activities and rehabilitation personnel, were required to help during meals due to the high number of residents needing eating assistance. The unit manager acknowledged that the administration and DON were aware of the staffing challenges and the heavy assistance needs on the unit. Additionally, staff members referred to residents requiring eating assistance as "feeders" in the presence of other residents and a family member. Both the activities leader and a CNA admitted they were unaware that using the term "feeder" was inappropriate. These actions and language choices failed to uphold the residents' right to dignity and respect as outlined in the facility's Resident Rights policy.

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