Insufficient Staffing Led to Delayed Feeding and Inappropriate Attire in Dining Area
Penalty
Summary
The deficiency involves the facility’s failure to provide sufficient nursing staff to maintain the highest practicable psychosocial well-being of a resident who was dependent for all ADLs and required full assistance with eating. The resident had severe cognitive impairment (BIMS score of 0), highly impaired vision, unclear speech, and multiple medical diagnoses including dementia, dysphagia, psychosis, delusional disorder, depression, anxiety, and significant physical limitations such as muscle weakness, difficulty walking, and unsteadiness. The MDS documented that the resident was dependent for eating and all ADLs, required a mechanically altered diet, and needed to be up in a chair for meals with assistance for intake per speech therapy. On the morning of the survey observation, breakfast trays arrived to the memory care unit shortly before 8:00 A.M. At 8:55 A.M., the resident was observed sitting alone in the dining room in a wheelchair, wearing a hospital gown that was open in the back, leaving his back and legs exposed, with a full breakfast tray in front of him. No staff were present in the dining area, and the resident was not feeding himself. A CNA confirmed that the resident had been brought to the dining room in the hospital gown because there was not enough time or enough staff to get him dressed before breakfast, despite knowing this attire was not appropriate for the dining room. The care plan included interventions for fall risk and having the resident eat meals in the all-purpose room for closer monitoring when awake. The resident remained without feeding assistance until 9:23 A.M., when another CNA arrived from a different unit and began feeding him, giving a few bites without reheating the food and then completing the meal. This CNA believed the resident sometimes fed himself and was unsure why he had not been fed earlier, estimating that breakfast trays arrived around 8:00 A.M. An LPN stated that nurses helped feed residents when they could but that mornings were very busy with medication pass, and she believed it was acceptable for a resident to be in the dining area in a hospital gown, even though the resident could not choose his clothing due to cognitive impairment. The resident’s spouse reported that he had required assistance with eating since a recent hospitalization for pneumonia and that she came daily to feed him lunch, noting that staff response could be delayed because they were very busy. The facility’s Dignity, Respect, and Privacy Policy required that residents be treated with respect and cared for in a manner that protected their privacy.
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