Failure to Provide Timely 1:1 Feeding Assistance and Meal Supervision
Penalty
Summary
The deficiency involves the facility’s failure to provide required 1:1 feeding assistance and timely meal support to a resident identified as being at risk for malnutrition. During a noon meal observation in the resident’s room, the resident was positioned in high Fowler’s with a towel placed around the chest and an open meal tray set on the bedside table. When asked, the resident opened his eyes, nodded that he wanted to eat, and verbally stated he needed help eating, but no CNA was present to assist. The tray remained open and unattended in front of the resident for approximately 16 minutes before any staff entered the room to help. When CNA 1, who stated the resident was not on her assignment, entered the room, she indicated she could assist and provided one spoonful of food before leaving to get water, then returned several minutes later to resume feeding. CNA 1 acknowledged that the resident required 1:1 feeding assistance and that leaving a tray open for a long time could cause the food to become cold, which she stated was not acceptable. Review of the resident’s records showed diagnoses including anemia, muscle weakness, and oropharyngeal dysphagia, with a history and physical indicating capacity to understand and make decisions, and an MDS documenting severe cognitive impairment and dependence on staff for ADLs, with partial/moderate assistance needed for eating. Physician’s orders and the nutritional care plan both specified that the resident was a 1:1 feeder and required 1:1 feeding assistance. CNA 3, who was assigned to the resident on the day of the observation, reported that her practice was to pass trays to other residents first and then bring trays to residents needing 1:1 feeding. She stated that she placed a towel on the resident, opened the meal tray in front of him, observed him open his eyes, and then left the room to pass other trays, intending to return in about 10 minutes but did not check back or return to see if he was eating. CNA 3 acknowledged that leaving the tray open could cause the food to get cold and that it was not acceptable to leave a tray unattended for 20 minutes in front of a resident who could not eat independently. RN 1 and the DON both stated that residents requiring 1:1 feeding should not have trays left in front of them without assistance, and the facility’s “Meal Supervision and Assistance” policy specified that meals should not be served until the attendant is ready to assist the resident.
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