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F0807
D

Failure to Obtain and Provide Resident Beverage Preferences for Hydration

Tulare, California Survey Completed on 05-08-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to obtain and provide beverages consistent with a resident's preferences, as required to maintain proper hydration. During an interview and observation, the resident reported that she was only given the drinks available in the kitchen and that no one had asked her about her beverage preferences. The resident expressed a preference for drinks such as Pepsi, Kool-Aid, and pineapple juice, but these were not routinely offered. Review of the resident's records showed that while food preferences were updated, beverage preferences were not specifically documented, and the drinks provided were based on standard facility offerings rather than individualized choices. The resident had significant medical concerns, including a recent 21.3% weight loss over three months, decreased oral intake, multiple wounds (including a stage 4 pressure injury and trauma wounds), and a recent hospitalization for syncope with IV hydration. The facility's policies required that beverage preferences be obtained and reflected in the care plan, but the resident's care plan did not include beverage preferences or person-centered goals related to hydration. Staff confirmed that only routine beverages were offered and that there was no specific policy guiding the collection of beverage preferences beyond general food preferences.

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