Failure to Assist Cognitively Impaired Resident with Eating and Drinking
Penalty
Summary
A deficiency was identified when a resident with Alzheimer's disease, diabetes, hypertension, right hip fracture, and anxiety disorder was not provided with necessary assistance during mealtimes. The resident, who was dependent on staff for eating and drinking due to impaired cognition and physical limitations, was observed sitting in a reclined Broda chair with her meal tray placed out of reach. Staff failed to position her upright, uncover her food, unwrap her silverware, or provide a straw for her milk. No encouragement or assistance was offered, and the tray was removed without any attempt to help the resident eat or drink. Documentation in the electronic medical record showed inconsistent and incomplete entries regarding the resident's meal intake and assistance provided. On several occasions, there was no documentation of meal intake or refusals, and the resident's intake varied from refusing to eat to consuming up to 75 percent of meals. The care plan and nutritional assessment indicated that the resident was unable to make her needs known and required substantial to maximum assistance with eating, yet these interventions were not consistently implemented by staff. Interviews with staff revealed a lack of understanding and follow-through regarding the resident's needs. One CNA, new to the facility, stated she was told the resident did not eat breakfast and therefore did not attempt to assist her. The LPN assigned to the unit was unaware of any specific instructions regarding the resident's eating habits. Both the dietitian and RN/unit manager confirmed that the resident was dependent on staff for eating and drinking and should have been properly assisted, including being positioned upright and having her food and drink made accessible.