F0726

D

Unsupervised New CNA Assisted High-Risk Resident With Eating Without Demonstrated Competency

Houston, Texas Survey Completed on 01-13-2026

Penalty

No penalty information released

Summary

The facility failed to ensure that a nurse aide demonstrated competency in skills and techniques necessary to meet a resident’s assessed needs and care plan requirements for safe eating assistance. The resident involved was an elderly individual with dementia, muscle wasting, dysphagia, severely impaired cognition, and limited functional range of motion in all extremities. Her Quarterly MDS documented that she required substantial/maximal assistance for eating, and her care plan identified her as being at risk for choking and aspiration related to difficulty swallowing, with instructions that her head of bed be elevated more than 45 degrees, with 90 degrees being optimal, during meals. On observation, the resident was receiving a pureed diet and required slow, assisted feeding with the head of bed elevated.

Despite these needs, the facility allowed a newly hired CNA, on her first day of orientation, to assist this resident with eating without supervision. CNA F, who was assigned as the orienting CNA, reported that on the first day of orientation the new CNA assisted the resident with her meal and worked with her alone for 15 minutes. A family member later reported, based on video review, that the new CNA had worked with the resident for 45 minutes without supervision. The ADON stated that the first day of orientation should be shadowing only, with no hands-on care, and acknowledged that each resident has a profile that takes time to learn and that complications could arise from using the wrong technique or not following the care plan if staff are not properly trained. The facility’s own CNA orientation policy required appropriate instruction on any identified skill weaknesses prior to delivering or completing a task, which was not followed in this instance.