Failure to Maintain Nutritional Status and Properly Assess Dialysis-Related Needs
Penalty
Summary
The facility failed to provide adequate care and services to maintain acceptable nutritional status for two residents. For one resident with a history of stroke, diabetes, and cognitive impairment, the care plan required substantial to maximal assistance with eating, a soft diet with double portions, and nutritional shakes. Despite these interventions, the resident experienced significant weight loss over a two-month period. Observations revealed that staff did not consistently provide the required assistance during meals, and the resident was often left unattended with food and nutritional shakes, resulting in incomplete consumption. Additionally, the kitchen was not informed of the double portion requirement, so the resident did not receive the prescribed diet enhancements. Documentation in the electronic medical record for this resident did not reflect the observed weight loss, and there was a lack of communication and follow-through regarding dietary interventions. Staff interviews confirmed that the resident's need for assistance with eating had increased, but this was not consistently addressed during meal times. The facility also lacked a restorative aide, and nurse aides were expected to provide the necessary support, which was not reliably done. For another resident with end-stage renal disease on dialysis, the facility failed to properly assess and document nutritional needs related to dialysis. The baseline care plan did not include any information about dialysis care, dietary restrictions, or fluid management, despite hospital discharge instructions specifying a diabetic, heart-healthy diet. Orders for daily and weekly weights were not consistently followed, and the registered dietitian's assessment did not address the resident's dialysis status. Staff interviews confirmed that essential dialysis-related care and monitoring were missed, and the care plan was incomplete regarding the resident's specialized needs.