Failure to Provide Dignified, Preference-Consistent Dining Care
Penalty
Summary
The deficiency involves the facility’s failure to provide a dignified dining environment and to honor resident preferences and diet orders for two residents. One resident with multiple diagnoses including Parkinson’s disease, dysphagia (oral phase), repeated falls, spinal stenosis, orthostatic hypotension, and moderate cognitive impairment (BIMS score 12) had an active order for a regular diet with puree texture and thin liquids. Despite this order, the resident reported receiving only one pureed meal since the diet change and, on observation, was served a regular breaded fish fillet with cheese, a whole hamburger bun, and green beans. The meal ticket showed the regular diet scratched out with “puree” handwritten, but the food provided was not pureed or cut up as the resident stated was needed and as he reported was documented in his chart. On a subsequent day, the same resident was observed in bed at mealtime, with a CNA assisting to sit him up in bed and then leaving the room. The resident stated he had requested to be placed in a chair instead of eating in bed, explaining that sitting in bed restricted his ability to feed himself and caused him to spill food because his movement was restricted. He reported that staff did not listen to his request, that he asked to be put in a chair every day so he could feed himself, and that staff told him it was not their job. During another observation, while a different CNA was feeding him, the resident again stated he could feed himself if seated in a chair but could not do so in bed. A care card posted in his closet documented him as an “independent feeder,” indicating a discrepancy between posted care information and the assistance and positioning actually provided. Another resident with multiple cardiac and renal diagnoses was observed being fed lunch in bed by the same CNA, who was standing over the resident while feeding. The CNA stated that this resident was “not a feeder” but that she was helping because he was having trouble, and also stated she always stands when feeding residents. Another CNA confirmed that when feeding a resident, she stands up. The DON stated that when feeding a resident, staff are supposed to sit so they are at the same level as the resident and not hovering over them, and that if a resident asks to sit in a chair, they should be gotten up to the chair unless there is a reason they cannot. Facility policies and CNA job descriptions require that residents be treated with dignity, respect, and reasonable accommodation of needs and preferences, including during feeding and dining, but the observed practices and resident reports showed that these standards were not followed for these residents.
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