Failure to Honor Resident Beverage Choice and Self-Determination
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to make choices about aspects of his daily life, specifically his beverage preference. The resident was an adult male with multiple diagnoses including vascular dementia, type 2 diabetes mellitus, hypertension, chronic systolic congestive heart failure, COPD, seizure disorder, left-sided hemiparesis, hemiplegia, and peripheral vascular disease. His quarterly MDS showed a BIMS score of 10, with cognitive skills for daily decision-making documented as independent. Review of his care plan revealed no restrictions related to soda, caffeine, or other beverages. According to a psychological services progress note and subsequent interviews, the resident reported that on a late-night occasion he requested a soda from a female CNA, who refused and told him it was too late for a soda and offered water instead. The resident stated he felt angry, asserted that he could make his own decisions, and reported that the CNA ignored him and walked away. He reported that this interaction made him feel like the facility did not care about his preferences. A family member, who had video cameras installed in the resident’s room, stated they reviewed the footage after the resident reported the incident and confirmed hearing the CNA offer water instead of soda. In interviews, the CNA involved stated she knew the resident already had a soda and, based on her own judgment, thought it would be best to offer water, acknowledging that she should have provided the soda and consulted the charge nurse. Another CNA present at the time stated it was wrong not to ask a supervisor and that denying the soda could cause the resident to feel his choices were not being considered. The DON and Administrator both stated that residents have the right to make choices regarding food and beverage preferences unless medically contraindicated, that there were no indications in this resident’s care plan restricting soda at night, and that staff are responsible for respecting resident wishes. The facility’s Resident Rights policy states that residents have the right to self-determination, to make choices about aspects of their life in the facility, and to exercise their rights without interference, coercion, discrimination, or reprisal.
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