Failure to Properly Position Resident During Meals
Penalty
Summary
A deficiency was identified when a resident with diagnoses including dementia, dysphagia (oropharyngeal phase), and a history of falls was observed eating lunch while lying in bed with the head of the bed at approximately 30 degrees, rather than in an upright position. The resident's lunch tray was placed on the bedside table across the bed, and the resident was seen feeding themselves in this position. Staff interviews confirmed that the resident was not properly positioned for eating, with both a Licensed Practical Nurse and a Certified Nursing Assistant acknowledging that the resident should have been repositioned to at least a 45-degree angle to prevent aspiration. The CNA admitted to placing the meal tray without first repositioning the resident and stated an intention to reposition the resident in the future. The resident's care plan specifically indicated the need for upright positioning during meals due to a swallowing problem, and the resident required setup or clean-up assistance for eating as well as partial/moderate assistance to move from lying to sitting. Despite these documented needs, the facility did not have policies in place for choking or aspiration precautions, nor for feeding setup in bed, as confirmed by the Administrator and Director of Nursing. The lack of proper positioning and absence of relevant policies contributed to the deficiency in ensuring the resident did not lose the ability to perform activities of daily living safely.