Failure to Knock Before Entering Resident Rooms Violates Resident Rights
Penalty
Summary
Surveyors identified that staff at the facility failed to consistently honor residents' rights to privacy and dignity by not knocking before entering residents' rooms. Observations revealed that both a Physical Therapy Assistant (PTA) and a Registered Nurse (RN A) entered the rooms of three residents without knocking. These incidents were directly observed on multiple occasions, involving residents with varying cognitive abilities, including one resident with severe cognitive impairment and others with intact cognitive responses. Interviews with the affected residents and a resident's Power of Attorney (POA) confirmed that staff did not always knock before entering. One resident expressed that while it did not upset her, she would prefer staff to knock. Another resident stated that she would like staff to knock, as it could be irritating when they did not, and she sometimes had to remind them. The POA for a resident with severe cognitive impairment noted that nurses mainly did not knock but did not feel it was necessary. These interviews highlight that the practice of not knocking was noticed by residents and their representatives. Staff interviews, including those with the PTA, RN A, the Director of Nursing (DON), and the Administrator (ADM), confirmed that facility policy requires staff to knock before entering any resident's room, except in emergencies. Staff acknowledged awareness of this policy and the importance of respecting residents' privacy. Despite this, staff could not explain why the policy was not consistently followed, and monitoring was reportedly done through rounds and spot checks. The facility's written policy also affirms residents' rights to dignity, courtesy, and privacy.