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F0561
E

Failure to Provide Consistent Dining Room Access for Dinner

Santa Monica, California Survey Completed on 06-16-2025

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 honor residents' rights to self-determination and choice by not consistently opening the dining room for dinner to all residents every day. Interviews with staff, including the activity director (AD) and restorative nursing assistant (RNA), revealed that while the dining room was regularly open for lunch, it was not always available for dinner. The AD stated that since their employment, residents typically ate breakfast and dinner in their rooms, and the dining room was only used for lunch. The RNA confirmed that the dining room operated from 9:00 a.m. to 4:00 p.m., with no clear information about dinner service. The director of nursing (DON) initially believed the dining room was open for all meals but later learned from the AD that staffing shortages prevented consistent dinner service in the dining room. A review of a specific resident's records showed that the resident, who had intact cognition and was independent with eating and mobility using a manual wheelchair, normally ate dinner in his room due to the lack of staff to facilitate dinner in the dining room. The resident indicated that this issue had been previously discussed with facility administration but was never resolved. Facility policies reviewed stated that all residents should be encouraged to eat in the dining room and that staff should assist those who require help with meals, emphasizing dignity and respect. The facility's own policies on resident rights and meal assistance highlighted the importance of supporting resident choice and providing a dignified dining experience. However, the practice of not opening the dining room for dinner to all residents every day was found to be inconsistent with these policies and constituted a violation of residents' rights to self-determination and choice regarding their dining preferences.

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