Health inspection·April 12, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to promote dignity in dining for 1 of 1 resident reviewed for dignity, of a total sample of 16 residents, (#4). Findings: Review of resident #4's medical record revealed she was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, dementia, and legal blindness. Review of resident #4's Minimum Data Set (MDS) annual assessment with Assessment Reference Date 2/22/24 revealed a Brief Interview for Mental Status score of 0 out of 15, which indicated she was cognitively impaired. The MDS assessment noted resident #4 was totally dependent on staff for activities of daily living (ADLs), including eating. Review of resident #4's care plan, revised on 2/23/24, revealed she required staff assistance with ADLs. Approaches included to, Assure dignity by providing privacy during care, and Provide assistance with meals as needed. Review of resident #4's nutritional status care plan, revised on 2/29/24, revealed she received a mechanically altered diet and required feeding assistance. On 4/10/24 at 1:20 PM and 1:25 PM, Certified Nursing Assistant (CNA) A was observed feeding resident #4 while standing over her in the hallway. On 4/10/24 at 1:31 PM, CNA A acknowledged she was standing while feeding resident #4 her lunch. She indicated resident #4 usually ate in the dining room but was unable to make it there because she had an appointment with the podiatrist just before lunch. She mentioned she had asked her co-worker to bring her a chair, but the other CNA was busy. She validated she should sit down when she fed residents who needed assistance to eat but was unable to explain why she had not been sitting. She said, I know I am not supposed to be standing because of safety and positioning. On 4/10/24 at 2:10 PM, CNA B explained she had a new resident who required eating assistance and she performed this task while standing. She indicated when the resident ate in bed, it was more comfortable for her to stand next to the resident to feed her. She added she knew she should sit down but could see what was going on with the resident better while standing. On 4/10/24 at 2:46 PM, CNA C explained when one of her residents returned from dialysis, she warmed Page 1 of 2 105839 105839 04/12/2024 Terrace of Kissimmee, The 221 Park Place Blvd Kissimmee, FL 34741

F 0550 Level of Harm - Minimal harm or potential for actual harm his food up and fed him because he was a, Feeder. When asked if she referred to residents who needed eating assistance as, Feeders, she stated she was not sure if she should refer to them as, Feeders, or not. On 4/10/24 at 4:02 PM, CNA D stated her unit had, A lot of Feeders. When asked if residents who required eating assistance should be referred to in that way, she apologized. Residents Affected - Some On 4/11/24 at 10:09 AM, the Unit Manager (UM) for the South Wing explained she tried to send the Feeders to the dining room because they had more help there. She indicated she sent one to two CNAs to the dining room and always the unit secretary for each meal to assist with the Feeders. She added there was an assigned area for the Feeders. The UM stated she did not observe CNA A assisting resident #4 to eat while standing and acknowledged it was not the facility's practice to do so. When asked if staff should refer to residents as Feeders, she said it was their culture and they needed to fix it. On 4/11/24 at 4:31 PM, the Assistant Director of Nursing explained they had an area for residents who required staff assistance in the dining room, and they were served last. She indicated residents who preferred to stay in their rooms, were assisted by their assigned CNAs. She stated CNAs were expected to be seated at resident's eye level, while assisting them to eat. She indicated staff were expected to refer to residents who required eating assistance as, Assisted diners. She said, It is a dignity issue. She explained they often reviewed resident rights and covered these topics. The Assistant Director of Nursing stated she was very surprised by these findings. Later at 5:30 PM, she indicated they had 13 residents who were dependent on staff for eating assistance. Review of the facility's policy titled Resident Rights dated 11/23/20 read, Employees shall treat all residents with kindness, respect, and dignity. Review of the facility's policy titled Assistance with Meals dated 2001 read, Residents shall receive assistance with meals in a manner that meets the individual needs of each resident. The form included a section for Residents Requiring Full Assistance which read, residents who cannot feed themselves will be fed with attention to safety, comfort, and dignity, for example: Not standing over residents while assisting them with meals; . avoid the use of labels when referring to residents (e.g. Feeders) . 105839 Page 2 of 2