Based on clinical record reviews, observations and staff interviews, it was determined that the facility failed to ensure that meals were served in a manner that maintained or enhanced each resident's dignity for seven of 70 residents reviewed (Residents 39, 52, 69, 87, 96, 109, 144).
An annual Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 39, dated July 20, 2019, revealed that the resident was severely cognitively impaired, required extensive assistance with her daily care, including eating, and had medical diagnoses that included hemiplegia (paralysis on one side of the body). The resident's care plan, dated November 7, 2018, revealed that the resident had required extensive assistance for eating.
Observations during the breakfast meal in the Skilled dining room on October 1, 2019, at 8:20 a.m. revealed that Resident 39 was seated at the same table as Residents 38 and 94. At 8:27 a.m. Resident 38 received her breakfast meal and at 8:29 a.m. Resident 94 received her breakfast meal. At 8:52 a.m. staff obtained a sippy cup with chocolate milk and sat down beside Resident 39 and helped her begin to drink it.
Interview with Licensed Practical Nurse 5 on October 1, 2019, at 1:05 p.m. revealed that Resident 39 had to wait for someone to come feed her.
Interview with the Director of Nursing on October 1, 2019, at 3:30 p.m. revealed that it was the facility's practice to feed all the residents seated at the same table at the same time. She confirmed that Resident 39 should have received her breakfast meal at the same time as the other residents seated at her table.
A quarterly MDS assessment for Resident 69, dated September 15, 2019, revealed that the resident was cognitively impaired and required staff assistance for eating.
Observations during the lunch meal in the Memory Support Unit (MSU) on September 30, 2019, at 12:05 p.m. revealed that Resident 69 was served puree consistency food items on a plate with raised edges, he was not given silverware, and he began to eat the food with his hands. Activity Aide 10 was seated next to Resident 69, was feeding Resident 81, and she did not get silverware for Resident 69. At 12:08 p.m., the Dietician gave Resident 69 some silverware and he finished his food by 12:10 p.m., at which time he tried scraping more food out of the plate, but it was empty. Activity Aide 10 called out multiple times for someone to get Resident 69 a sandwich. At 12:28 p.m., the Dietician brought Resident 69 a sandwich; however, Nurse Aide 11 removed the sandwich and stated, "He is pureed." Resident 69 was then given a bowl of mashed potatoes and some ice cream, and he ate all of it.
Interview with the Dietary Manager on October 1, 2019, at 5:14 p.m. confirmed that all of the residents should have silverware and drinks in front of them with their meals.
An admission MDS assessment for Resident 96, dated August 7, 2019, revealed that the resident was cognitively impaired and required extensive assistance for eating.
Observations during the lunch meal in the Memory Support Unit on September 30, 2019, at 11:57 a.m. revealed that Resident 96 was seated at a table with three other residents. She repeatedly wheeled herself away from the table, and staff redirected her and put her back to the table; however, she had no food, drink or anything else on the table. Resident 96's tablemates were served food at 12:07 p.m., 12:17 p.m. and 12:22 p.m. Resident 96 was not served food or drink until 12:24 p.m., and after the food and drink items were put in front of her, she continued to wheel herself away from the table. At 12:32 p.m., Nurse Aide 11 sat down to feed Resident 96. Interview with Nurse Aide 11 on September 30, 2019, at 12:45 p.m. revealed that she served Resident 96 last because the resident needs staff to cue her to eat and there was no one available to sit with her until after she (Nurse Aide 11) served all of the other residents, as other staff members who were scheduled to work had called off.
Observations during the lunch meal in the Memory Support Unit on September 30, 2019, at 11:57 a.m. revealed that Residents 87, 96 and 144 were seated in Broda chairs (an adaptive wheelchair that is low to the ground and that can be reclined) in a reclined position. The residents were served food, but were not placed into an upright position and could not reach their food and drink without stretching. Observations of Residents 52 and 109 revealed that they were seated in geri-chairs (a padded chair on wheels that can recline) and they were in a reclined position during the meal. Observations of Resident 109 revealed that each time he wanted a bite of food he had to reach up and over the table to get a bite, and then plopped back into the chair.
Interview with Nurse Aide 11 on September 30, 2019, at 12:45 p.m. revealed that Residents 52, 87, 96, 109 and 144 should have been seated in an upright position for their meals and they were not.
28 Pa. Code 201.29(j) Resident rights.