Failure to Maintain Adequate Nutrition and Timely Meal Replacement for Two Residents
Penalty
Summary
The facility failed to maintain adequate nutritional status for two residents. For one resident with a history of poor intake, meal refusals, and food pocketing, there was an 8-pound (5.8%) weight loss over one month. Despite the resident's ongoing issues with swallowing and refusal of pureed foods, no referral was made to a speech therapist, and interventions were limited to offering supplemental nutrition drinks, an appetite stimulant, and a pureed diet. Observations showed that the resident continued to refuse meals and consumed only a partial amount of a supplemental drink, resulting in insufficient caloric and protein intake. The resident's medical record indicated diagnoses including hypothyroidism, anxiety, depression, pain, and recent pneumonia. Nursing notes documented persistent meal refusals, pocketing, and spitting out food, with the resident expressing dislike for pureed foods. The Registered Dietitian had recommended an appetite stimulant and supplemental nutrition, but no further assessment or intervention for swallowing difficulties was initiated, as the facility lacked a therapy department and no physician order for a speech therapy consult was made. For another resident with diabetes, staff failed to offer a replacement lunch meal in a timely manner after the resident refused to eat and spilled her lunch tray during a behavioral episode. Although facility policy required staff to offer meal replacements at least twice following a refusal, the resident was only asked once and then not again. The DON confirmed that the resident should have been offered a replacement meal at least twice, but this did not occur, resulting in the resident not receiving adequate nutrition during that meal period.