Deficiency in Registered Dietitian's On-Site Participation
Penalty
Summary
The facility failed to meet professional standards of quality as required by §483.21(b)(3) Comprehensive Care Plans. The deficiency was identified through a review of facility policies, job descriptions, clinical records, and staff interviews. It was determined that the facility did not adhere to acceptable standards of practice concerning the participation of the Registered Dietitian (RD) in interdisciplinary meetings, monitoring of Food Service operations, conducting resident interviews, and participating in the Quality Assurance and Performance Improvement (QAPI) program. The RD, Employee E6, worked remotely for eight hours per week and had not been physically present in the facility for over a year. This arrangement did not allow the RD to fulfill the in-person duties outlined in the job description, such as encouraging resident and family participation in care plans, maintaining liaison with families and residents, and attending departmental meetings. Interviews with the RD and other staff members confirmed the lack of in-person involvement by the RD. The RD, located out of state, relied on email communication with the Dietary Manager (DM) and nursing staff to address dietary issues. The DM confirmed that she handled in-person communication with residents, while the RD managed remote assessments and documentation. The Nursing Home Administrator acknowledged the facility's failure to have an RD on-site to participate in interdisciplinary meetings, monitor Food Service operations, or perform any in-person duties as required by the job description. This situation arose because the facility had been unable to fill the position for an on-site RD, and the current RD had accepted the role temporarily to assist the facility until a permanent solution could be found.
Plan Of Correction
1. The facility failed to have a Registered Dietitian on premises that participated in interdisciplinary meetings, monitor Food Service operations, or completed any in-person actions of the Registered Dietitian Job Description. 2. The Dietary Manager/Administrator/Designee will be educated by the NHA/Designee. 3. Registered Dietician will be hired for on the premises and will participate in interdisciplinary meetings, monitor Food Service operations, and complete any in-person actions of the Registered Dietitian Job Description.