Failure to Honor Resident's Dignity and Preferences for Timely Assistance
Penalty
Summary
A deficiency was identified when a resident with diagnoses including diabetes mellitus type 2, congestive heart failure, dementia, and peripheral vascular disease was not treated with dignity and respect. The resident was observed repeatedly calling for help from their room early in the morning, but a CNA who was present on the unit did not respond or inquire about the resident's needs. Shortly after, an LPN entered the unit, acknowledged the resident's request for tea, but stated that she needed to get report first and would provide the tea later. The resident was left without water or tea at the bedside, and no bedside table was within reach. Over the course of several hours, the resident continued to wait for the requested tea, and multiple observations confirmed that the request was not fulfilled. The resident also expressed a desire to eat breakfast in the dining room, but remained in bed due to the need for a second staff member to assist with the transfer. By the time assistance was available, breakfast service in the dining room had ended, and the resident was required to eat in their room. The resident continued to express disappointment about not receiving tea and not being able to eat in the dining room as preferred. Eventually, the resident was transferred to a wheelchair and received a breakfast tray in their room, but the tray contained coffee instead of the requested tea. The LPN acknowledged not checking to ensure the resident received tea and only provided it nearly three hours after the initial request. Throughout this period, the resident's repeated requests for assistance and specific preferences were not promptly addressed, resulting in a failure to honor the resident's right to dignity, respect, and self-determination.