Failure to Provide Adequate Dietitian Oversight and Nutritional Care
Penalty
Summary
The facility failed to ensure that the Registered Dietitian (RD) provided adequate consultation and support for food and nutrition services, specifically in the assessment and development of individualized care plans for a resident who experienced significant weight changes. The RD was not consistently present at the facility, working irregular hours and often after completing work at another job. The RD did not participate in staff training, interdisciplinary team (IDT) meetings, or regular follow-up on residents' nutritional needs, including those triggered for weight changes. The Certified Dietary Manager (CDM) and Director of Nursing (DON) both indicated that the RD's involvement was limited, and the RD did not create or update care plans for residents, nor did he provide timely recommendations for residents with ongoing weight fluctuations. A review of records showed that the RD had only written one note in the affected resident's chart since January, despite the resident being flagged for significant weight changes in both February and March. The DON was unsure if the RD was aware of the resident's weight loss and confirmed that the RD was not involved in weekly IDT meetings where such issues were discussed. The RD's job description required him to assess and monitor residents' nutritional status, provide recommendations, develop and update care plans, and participate in audits and staff guidance, but these duties were not consistently fulfilled due to the RD's limited and inconsistent presence at the facility. The resident involved had a complex medical history, including hemiplegia, gastrostomy, and a history of stroke, and was assessed as having severe cognitive impairment. Despite being at high risk for nutritional issues, the resident did not receive adequate follow-up or individualized care planning from the RD. The facility's documentation and interviews confirmed gaps in the RD's recommendations and lack of ongoing monitoring, which was inconsistent with both facility policy and regulatory requirements for dietetic services.