Deficiencies in Resident Hydration and Meal Provision
Penalty
Summary
The facility failed to ensure that activities of daily living (ADLs) were adequately maintained for several residents, particularly concerning meals, snacks, and hydration. Resident #91 was observed in various locations without access to hydration and reported not having eaten lunch before a medical appointment. The resident was not provided with food during the appointment or upon returning to the facility, despite staff being aware of the situation. Interviews with staff revealed a lack of communication and coordination regarding the resident's meal arrangements, with the Certified Dietary Manager and nursing staff unaware of the resident's missed meal. Additionally, Resident #16 was observed without hydration while sitting in the activities room. The resident's medical records indicated a need for substantial assistance with eating, and the CNA responsible for the resident was unsure about the frequency of providing hydration. Similarly, Resident #49 was also observed without hydration in the activities room, with medical records showing a need for maximal assistance with eating. Staff interviews highlighted a lack of consistent hydration monitoring, with expectations for hourly checks not being met. The facility's policy on hydration and nutrition requires that residents receive sufficient food and fluids, with hydration always available. However, observations and staff interviews indicated that these procedures were not consistently followed, leading to deficiencies in resident care. The Director of Nursing and Regional Director of Clinical Services acknowledged the lack of monitoring and communication regarding resident hydration and meal arrangements, contributing to the identified deficiencies.
Plan Of Correction
Resident #91 was discharged from the facility. Resident #16 and 49 were assessed with no negative outcomes. Residents that are dependent on staff for hydration that spend time in the activity day rooms are at risk of not being offered and assisted hydration. Residents whose Activities of Daily Living are dependent on staff for hydration that spend time in the activity rooms were reviewed to ensure the necessary assistance and fluids are being provided while in the activity day rooms. Residents who have scheduled outings have the potential to be affected by not having staff arrange, provide, and complete alternative options for meals and/or snacks to accommodate the outing. Current residents were evaluated for negative consequences from not being provided a meal or snack with a scheduled outing. The Director of Nursing/Designee in-serviced the licensed and certified nursing staff on the hydration policy, including offering and providing assistance with fluids, meals, and snacks based on the residents' needs and plan of care. This training includes the facility process for residents who have scheduled outings, including communicating to the kitchen for timely tray delivery to accommodate the residents' needs and preferences with meals, hydration, and snacks during outings as needed. The Dietary Director will educate kitchen staff on the facility process for communicating and accommodating meal or snack delivery for residents. The Director of Nursing/Designee will complete 5 weekly activity day room observations of residents dependent on staff for hydration to ensure appropriate assistance and hydration is being offered to meet the residents' hydration needs. The Director of Nursing/Designee will also complete 3 random weekly interviews and/or observations to ensure residents are being provided an earlier meal/snack or meal/snack upon return based on resident need or preference. Results of the audits will be tracked, trended, and reported to the monthly Quality Assurance Performance Improvement meeting until sustained compliance is achieved.