Failure to Follow Care Plan for Meal Assistance for Cognitively Impaired Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide meal assistance in accordance with the care plan for a cognitively impaired resident who required set-up or clean-up assistance with eating and was dependent for all other ADLs. The resident had dementia, depression, anxiety, hypertension, muscle weakness, and a documented need for assistance with personal care. Nutritional assessments and orders showed he was on a regular diet with thin liquids and a house supplement twice daily, with documented weight loss over several months. His care plan, initiated shortly after admission, identified risk for decreased nutritional status and dehydration and included interventions to assist him with meals and feed as necessary, as well as to monitor intake and weight. During a lunch observation in the memory care unit dining room, staff placed the resident’s meal in front of him while two CNAs, the Activity Director, and Human Resources staff were present passing trays and assisting others. HR staff verbally discussed whether the resident needed food placed in his hand or just in front of him; when HR handed him a sandwich, he began eating, but HR then left and did not return. The Activity Director continued assisting another resident and only gave a verbal cue from across the table, which did not prompt the resident to use his utensils. The resident struggled for several minutes to open a cracker packet, ate the crackers, but left soup, potato salad, and fruit untouched, then closed his eyes and attempted to push back from the table. His nose was dripping when a CNA asked if he was done, then removed his largely untouched meal. Staff interviews indicated they believed he usually ate independently and needed only verbal cues, and that meal intake was documented from memory rather than at the time of the meal. The DON confirmed there was no specific ADL policy and that the care plan included assisting with meals and feeding as needed.
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