Survey Savvy For CNA’s: Dignity & Respect-Serving Meals

by Patti on May 29, 2012

in OBRA Inspections

Regulation Number:0241

Regulation Title: DIGNITY AND RESPECT OF INDIVIDUALITY

Regulation Description: The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.

From the survey:

II. Non-Secure Dining Room 2/8/12

At 4:45 p.m., a CNA was overheard asking another CNA at table #17 where the resident’s dentures were and then the CNA continued feeding the resident without obtaining the dentures. The other CNA rolled the resident out of the dining room and returned with the resident with the dentures in her mouth approximately ten minutes later. The resident’s food was not reheated for her and the CNA did not return to assist her with the rest of her meal.

On 2/8/12 at 4:58 p.m., the CNA returned to assist the resident with her meal, but did not reheat the meal for her. The resident stated that she was used to the food being cold and did not know that she could ask for the meal to be reheated or get the meal replaced. The resident laughed and stated “it’s ok… I can’t taste much anyhow.”

On 2/8/12 at 4:48 p.m., a resident was observed sleeping in her geri-chair at table #18, while everyone at her table was served and assisted with feeding. The resident was placed at the table in the geri-chair at 4:25 p.m. and did not get served until 4:57 p.m. after her table mates were done.

On 2/8/12 at 4:57 p.m., another resident was observed at table #19, getting seated in the dining room at 4:30 p.m. and not served until 5:00 p.m., after his table mates had completed their meals.

On 2/8/12 at 4:59 p.m., a resident at table #19 was not assisted with his meal. He struggled with one arm (right) to apply jelly to his bread. The resident was served at 4:30 p.m. He was assisted with the jelly on his bread at 4:52 p.m. After assisting the resident the CNA quickly left and began serving more residents.

On 2/8/12 at 5:14 p.m., CNAs observed at tables #19 and #20 were talking among themselves, not speaking often with the residents.

Do you see what’s wrong with this? First, the resident was brought to the dining room without her dentures. How undignified is that? How safe is it to feed someone without their dentures? Why did the other aide take the lady out?

Second, the resident was placed at the table sleeping, and was not woken up for over 25 minutes, and then was served her meal. And on and on it goes. Much of this is preventable. Even with just two CNA’s- it is possible to ensure meals go smoothly and that residents don’t have to wait.  First, have ALL the residents READY for the meal. This means awake, dentures in, sitting correctly. Next, make sure all meals are served to all the residents. Doing this quickly keeps the food hot or cold as served. Residents can be placed in a way where one aide can assist 6 or 7 at a time; this isn’t ideal, but it’s  better than ignoring a few for half an hour! I’ve always said it matters, a lot, the topics of discussion at meal times. We should not use this time to whine and complain about work, or husbands, or to talk behind other aides backs. Instead, meals are a great time to connect with the residents. Discussion topics can and should be about issues that matter to them: Some good ideas could come from the Activity staff- who probably have many books filled with trivia and conversation starters. On the market are flash cards designed just for this purpose- Table Talk.

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