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F0550
D

Failure to Ensure Resident Privacy and Dignity During Dining and Medical Assessment

Susanville, California Survey Completed on 09-12-2025

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 deficiency occurred when a resident with a history of major depression, anemia, fatigue, and a major neurocognitive disorder due to possible Alzheimer's Disease was not treated with dignity and respect regarding her preferences for privacy and dining location. The resident, who was not her own responsible party, repeatedly expressed a desire to return to her room during lunch and showed clear signs of distress and refusal to eat in the RNA dining room. Despite her verbal and non-verbal refusals, staff continued to encourage her to eat and did not promptly honor her request to leave the dining area. During the lunch period, the resident complained of abdominal pressure and expressed discomfort. Instead of providing a private assessment, a Licensed Nurse assessed the resident's lower abdomen at the dining table in the presence of three other residents. The nurse also discussed the resident's need to use the bathroom in front of others, which the resident later stated should have been a private and confidential conversation. Staff interviews confirmed that the resident was more comfortable eating in her room and that her rights to privacy and dignity were not upheld during this incident. Facility policy required staff to treat residents with respect and dignity, provide privacy and confidentiality, and support residents in exercising their rights. However, staff actions did not align with these policies, as the resident's preferences were not respected, and her medical concerns were addressed publicly. The Director of Staff Development acknowledged that the resident's rights were violated during this event.

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