§483.10(f) Self-determination.
The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.
§483.10(f)(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, and plan of care and other applicable provisions of this part.
§483.10(f)(2) The resident has a right to make choices about aspects of his or her life in the facility that are significant to the resident.
§483.10(f)(3) The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility.
§483.10(f)(8) The resident has a right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility.
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Observations:
Based on review of facility documents, and resident and staff interview, it was determined that the facility failed to promote and facilitate resident self-determination through support of resident choice and make choices about aspects of his or her life in the facility that are significant to the resident for 11 of 11 residents reviewed for availability of food preferences (Residents R1-R11).
Findings include:
Review of Resident Council Meeting minutes dated 2/06/24, revealed:
-resident concerns from two resident council members about having soup available daily. Review of the "Results of the Investigation" indicated that soup is offered on the current menus cycle, and one resident in the facility can receive soup for lunch and dinner per resident and family request. The "Resolution" lacked how the facility addressed the concerns how they directly related to the residents voicing the concerns and indicated that "Resident is pleased with outcome" but failed to indicate what the "outcome" was as it related to the residents voicing their concerns.
-resident concerns from one resident council member about getting ice cream when he/she doesn't like the served dessert. Review of the "Results of the Investigation" indicated that ice cream is offered weekly on the current menu cycle. The "Resolution" indicated that the Activities Department will host an ice cream social, and lacked how the facility addressed the concerns how they directly related to the resident's voiced concerns.
-resident concerns from one resident council member about the kitchen running out of eggs, having more fresh fruits and juice flavors. The "Results of the Investigation" lacked evidence that the facility investigated the resident's concern related to running out of eggs, and not getting enough fresh fruits and juices. The "Resolution" indicated that the Activities Department will host a breakfast bonanza including fresh fruits and eggs, and fresh fruit will be offered as a bingo prize, and fresh fruit will be offered in spring/summer menus and lacked how the facility how the facility addressed the concerns how they directly related to the resident's voiced concerns.
Review of the four week menu cycle revealed that soup was offered twice (once during week one and once during week three), ice cream is offered once a week, and canned fruit is offered an average of three times per week.
Observation on 2/07/24, at 9:45 a.m. revealed a sign posted on the kitchen access door in the resident dining room and indicated that as of 1/01/24, there was not pop/soda available to residents.
Interviews on 2/07/24, between 9:30 a.m. and 12:50 p.m. with 11 alert and oriented residents (Residents R1-R11) confirmed the following:
"they are not allowed to have fresh eggs, the only eggs available are scrambled, they would like the option of having sunny-side up available; the only pop available is Ginger Ale and then only provided if they are sick; they would like to have the option of different types available if they choose to have one, currently they are required to provide their own pop or buy it out of the vending machine at $2.00 per bottle and cannot afford to do that; if they do not like the meal they are served, their only choice is a sandwich to replace the protein; they would like to have the option of soup available if they do not like the meal being served."
During an interview on 2/7/24, at 11:20 a.m. Resident R2 confirmed that he/she likes cola but was told he/she could only have ginger ale if he/she was sick.
During an interview on 2/7/24, at 11:22 a.m. Resident R3 confirmed that he/she has eaten bacon/sausage/ham and a sweet roll for breakfast most of his/her adult life and used to be able to get that until recently, now he/she only eats the meat because he/she doesn't like eggs or cereal.
During an interview on 2/7/24, at 11:30 a.m. Resident R4 confirmed that since November there have been drastic changes to the food, he/she used to get coffee at all three meals, but now does not get it for dinner and doesn't know why.
During an interview on 2/7/24, at 11:35 a.m. Resident R5 confirmed that he/she has recently started drinking Ensure (special high calorie/protein nutritional drink) due to not liking several of the meals served, and that he/she would like soup daily and was told he/she wasn't allowed to, and that residents are required to buy pop out of the vending machine, and he/she cannot afford to.
During an interview on 2/7/24, at 11:37 a.m. Resident R6 confirmed that he/she has requested to be able to get soup when he/she doesn't like the meal he/she is served and stated "I know we order it a week or so ahead, but sometimes it doesn't taste good."
During an interview on 2/7/24, at 12:05 p.m. Resident R8 confirmed that he/she was told that he/she was not allowed to have sunny-side up eggs and pop.
Observation on 2/7/24, at 12:30 p.m. revealed Resident R10 balancing on his/her rolling wheeled walker in front of the soda vending machine inserting quarters to buy a soda. During an interview at that time, he/she confirmed that he/she "saves the quarters until there is enough to buy a pop."
During an interview on 2/7/24, at 10:50 a.m. the Dietary Manager confirmed that the facility only provides ginger ale when residents are sick, there are no fresh eggs on the menu guide sent from corporate, the always available food items are sandwiches, the resident likes and dislikes are entered into the menu system and the meal tickets are automatically generated to omit the disliked food item from that meal.
During an additional interview on 2/7/24, at 12:35 p.m. the Dietary Manager confirmed that soup and Danish/cinnamon roll are only available if they are on the menu guide for that day.
28 Pa. Code 201.29 (a) Resident rights
28 Pa. Code 201.18 (b)(2)(3) Management
| | Plan of Correction - To be completed: 03/13/2024
1.A Resident Council and Food Committee meeting will be scheduled, with the attendance of the nursing home administrator with permission of the Resident Council, to address resident specific concerns and recommendations of Resident Rights in Self-determination and resident choice. Ice cream is available as an alternative for any resident who does not want the dessert offered with the main entrée. Eggs are always available for the breakfast meal. Residents will have the option of selecting any style of egg on the menu or prepared to their request, as long as, it is approved by the American Dietetic Association and Serve Safe. Fresh fruit is available and will be provided as an option, when seasonally appropriate, at the request of the resident.
Residents will have the ability to request and be provided soda provided by a vending machine. An activity fund that is established to help pay for the soda for the residents and providing a choice of variety and selection of beverages. The facility also provides 3 different flavors of juice. Residents have the right to choose apple, orange, and/or cranberry juice with their meals. The residents will have the availability of coffee for all three(3) meals. Residents will have the right to request and choose soup if they do not prefer the main entree.
2.The Nursing Home Administrator will audit the previous 3 Resident Council and Food Committee Meeting minutes to identify any "Resolution" that lacks how the facility addressed residents' concern. The Activity Department will be educated on completing Resident Council Minute "Resolutions" directly related to resident concerns The Department Managers will be educated in providing a timely response to Resident Council Minutes that affect their department.
3.The Nursing Home Administrator will attend the Resident Council and Food Committee meeting, at the permission of the current Resident Council, monthly to address resident concerns. The Nursing Home Administrator will monitor Resident Council Minutes for the next 3 months to ensure "Resolutions" directly related to how the facility will address the concerns.
4.The Nursing Home Administrator will submit Resident Council Audits to the QAPI Committee for review and recommendations at the monthly meeting.
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