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F0550
D

Failure to Honor Resident's Beverage Preference

Pomona, California Survey Completed on 07-25-2025

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

A resident with dementia and severe cognitive deficits, who required supervision or assistance with eating and bed mobility, was observed repeatedly requesting milk while in their room. The resident pointed to the bedside table, which lacked both milk and a water pitcher. Despite the resident's repeated verbal requests, the Certified Nursing Assistant (CNA) present did not provide milk, nor did they seek assistance from other staff or leave the room to obtain milk. The CNA stated that the resident had already received milk, juice, and water during breakfast and noted that water was not at the bedside due to the resident's need for thickened liquids. The CNA acknowledged that the resident was likely asking for milk because they were thirsty or wanted milk. Review of the resident's records confirmed their cognitive and physical limitations, and the facility's policy indicated that residents should be offered meals and snacks according to their individual preferences. The failure to provide milk upon request, in accordance with the resident's expressed preference and the facility's policy, constituted a deficiency in honoring the resident's right to a dignified existence, self-determination, and communication.

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