Failure to Ensure Adequate Hydration for Cognitively Impaired Resident
Penalty
Summary
The facility failed to ensure that a resident with severe vascular dementia and a history of UTIs consistently received adequate fluids to meet their daily estimated needs of 1900 cc. Despite the resident's significant cognitive impairment and need for extensive assistance with eating, multiple observations over several days revealed that fluids were not consistently available at the bedside, and when present, were often out of reach. Documentation showed that the resident's daily fluid intake ranged from 336 cc to 1056 cc, never meeting the required amount. Family members expressed concern about the lack of fluids at the bedside during visits, and staff interviews confirmed that the resident rarely initiated drinking independently and required cues and hand-held assistance. Clinical records and care plans lacked specific documentation or interventions regarding hydration, aside from general encouragement for good nutrition and hydration. There were no recent laboratory assessments to monitor hydration status, and staff were not aware of any hydration concerns. Observations also noted physical signs of dehydration, such as a dry tongue. The administrator stated that the expectation was for nursing to provide water regularly and for dietary to supplement fluids as needed, but these practices were not consistently implemented or documented for this resident.