Failure to Provide Dignified Dining Experience
Penalty
Summary
Surveyors identified that the facility failed to ensure a dignified dining experience for four residents who were reviewed for dining practices. These residents, all with significant cognitive impairments and various diagnoses such as dementia, depression, anxiety, dysphagia, and nutritional deficits, were observed eating their meals in the hallway rather than in a designated dining area. Observations on two consecutive mornings showed these residents lined up against the hallway wall, with some being fed by staff and others eating independently. The residents' care plans did not reflect that meals would be taken in the hallway, nor did they address the circumstances under which this would occur. Interviews with facility staff revealed a lack of clarity and consistency regarding the rationale for hallway dining. One RN stated that residents were placed in the hallway due to fall risks and insufficient staffing to open the dining room for breakfast. A nursing assistant was unaware of the reason for hallway dining, and the Director of Nursing Services (DNS) acknowledged awareness of the practice but could not specify which residents were affected. The DNS also noted that the dining room had not reopened for breakfast since the onset of COVID-19, and that nursing staff were responsible for ensuring residents were in the dining room if it was open. The Care Plan Coordinator confirmed that care plans did not address hallway dining, as she was unaware of which residents ate meals in the hallway. The facility was unable to provide a policy on dining when requested. Physician orders for the residents specified various dietary needs and precautions, including soft or puree diets, small bites, alternating solids and liquids, and supervision during meals. However, these orders and the residents' care plans did not address or justify the practice of eating in the hallway, nor did they document any individualized assessment or planning for this arrangement.