§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 policy, clinical records, observations, and resident and staff interviews it was determined that the facility failed to promote self-determination through the support of resident choices about aspects of their lives that were identified as important for five of 24 residents reviewed (Residents R14, R37, R40, R82, and R186).
Findings include:
A facility policy entitled, "Dining and Food Preferences" dated 1/16/24, indicated the following:
- licensed nurse will notify the dining services department of food allergies upon admission and prior to any meals served. - Dining Services Director or designee will interview the resident/representative to complete a Food Preference Interview within 48 hours (two days) of admission. - Food Preference Interview will be entered into the medical record. -Food allergies, food intolerances, food dislikes, and food and fluid preferences will be entered into the resident profile menu management software system. - individual tray assembly ticket will identify allergies, food and beverage preferences, and special requests.
Resident R14's clinical record revealed an admission date of 11/19/23, with diagnoses including broken left thigh, difficulty swallowing, chronic obstructive pulmonary disease (COPD- a group of diseases that cause airflow blockage and breathing-related problems), heart failure, Type 2 Diabetes (condition that affects how the body uses glucose [sugar]), and high cholesterol.
Observation on 1/24/24, at 12:10 p.m. revealed Resident R14's individual tray assembly ticket lacked identification of food/beverage likes and dislikes, and special requests.
During an interview at that time Resident R14 confirmed that he/she has told staff of his/her dislike of eggs and continues to receive them almost every day.
Resident R37's clinical record revealed an admission date of 11/09/23, with diagnoses including broken right thigh, pelvis, and lower back, high cholesterol, kidney disease, heart failure, and gastro-esophageal reflux disease (GERD- occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach (esophagus).
Observation on 1/24/24, at 12:13 p.m. revealed Resident R37's meal tray contained beets, and the individual tray assembly ticket lacked identification of food/beverage likes and dislikes, and special requests.
During an interview at that time Resident R37 confirmed that he/she does not like beets.
Resident R40's clinical record revealed an admission date of 1/08/24, with diagnoses including Type 2 Diabetes, high cholesterol, GERD, kidney disease, and anemia.
Observation on 1/24/24, at 12:16 p.m. revealed Resident R40's meal tray contained beets and an opened four-ounce carton of milk, and the individual tray assembly ticket indicated coffee, milk, and no fish.
During an interview at that time Resident R40 confirmed that he/she does not like beets and does not drink milk due to it not "agreeing" with him/her.
Resident R82's clinical record revealed an admission date of 1/04/24, with diagnoses including bone infection of the lower back, obesity, anemia, and high blood pressure.
Observation on 1/24/24, at 12:20 p.m. Resident R82's meal tray contained beets, and the individual tray assembly ticket lacked identification of food/beverage likes and dislikes, and special requests.
During an interview at that time Resident R82 confirmed that he/she does not like beets.
During an interview on 1/24/23, at 12:30 p.m. Nurse Aide (NA) Employee E1 confirmed the following:
-Resident R14 does not like eggs and receives them for breakfast, and the individual assembly meal ticket lacked food/beverage likes and dislikes, and special requests. -Resident R37's meal tray contained beets, and the individual assembly meal ticket lacked food/beverage likes and dislikes, and special requests. -Resident R40's meal tray contained beets, and an opened four-ounce carton of milk, and the individual assembly meal ticket lacked food/beverage likes and dislikes, and special requests. -Resident R82's meal tray contained beets, and the individual assembly meal ticket lacked food/beverage likes and dislikes, and special requests.
Resident R186's clinical record revealed an admission date of 1/13/24, with diagnoses including bone infection of the foot, Type 2 Diabetes, high cholesterol, high blood pressure, and GERD.
During an interview on 1/23/24, at 3:10 p.m. Resident R186 confirmed that noone has met with him/her for his/her food likes and dislikes.
Observation on 1/24/24, at 12:40 p.m. Resident R186's meal tray contained beets and one coffee, and the individual tray assembly ticket lacked identification of food/beverage likes and dislikes, and special requests.
During an interview at that time Resident R186 confirmed that he/she wants two coffees with each meal and does not like beets.
During an interview on 1/24/24, at 12:50 p.m. NA Employee E2 confirmed that Resident R186's meal tray contained beets and one coffee, and the individual assembly meal ticket food/beverage likes and dislikes, and special requests.
During an interview on 1/26/24, at 9:30 a.m. the Dietary Manager confirmed there was no evidence the Food Preference Interview was completed within 48 hours of admission, and no documentation of resident likes, dislikes, allergies, and special requests/choices for the above identified residents.
28 Pa. Code 201.18 (b)(1)(e)(1) Management
28 Pa. Code 201.24.(e)(4) Admission Policy
28 Pa. Code 201.29(a) Resident rights
| | Plan of Correction - To be completed: 03/06/2024
1. What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? Residents 14, 37, 40, 82, & 186 were interviewed and completed food preferences. Residents likes/dislikes, allergies, and special requirements/choices were updated for those residents and meals tickets were updated to match. 2. How the facility will act to protect residents in similar situations. Audit completed for current residents to validate that food/preference interviews had been completed. 3. How will you identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken? Administrator or designee will educate the Dietary Manager on completing the Resident Preference interview within 48hrs of admission per facility policy. Ed. signed 4. Measures the facility will take or systems it will alter to ensure that the problem does not recur. Audit of 5 residents will be completed to ensure that residents have a food/preference interview completed within 48hrs of admissions. Audit will be completed wkly x 3wks then monthly until compliance is met. Audits will be reviewed at QAPI meeting monthly. Audits will be completed by the DON or designee.
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