Failure to Ensure Proper Hydration for Dependent Resident
Penalty
Summary
Surveyors identified a deficiency in the facility's failure to ensure proper hydration for a resident who was totally dependent on staff for eating and drinking due to quadriplegia, dementia, and other significant medical conditions. Multiple observations over several days revealed that the resident was often found in bed or in a wheelchair without fluids accessible at the bedside, and there was no evidence that staff were offering fluids during activities or throughout the day. The resident's water cup was observed to remain at the same level for extended periods, indicating fluids were not being consumed or offered as needed. Interviews with the resident's family and staff confirmed that the resident was unable to request or obtain fluids independently and required total assistance. The family expressed concern that staff were not checking on the resident frequently enough or offering fluids as needed. Staff acknowledged that the resident was at high risk for dehydration and that the expectation was to offer fluids every two hours, especially for residents with recurring UTIs and other risk factors. However, there was no care plan focus or physician order in place to ensure fluids were encouraged or offered at the required frequency. A review of the resident's medical record and care plan showed the resident was assessed as high risk for dehydration, but interventions specific to hydration were not implemented. The facility was unable to provide a dehydration policy, and there was no documentation of a plan to address the resident's hydration needs, despite the resident's total dependence and high-risk status.
Plan Of Correction
1) Resident #58 was assessed on 08/05/2025 by Licensed Nurse, with no adverse effects noted. The Director of Nursing Services and Registered Dietitian reassessed the hydration status and fluid needs for resident #58 on 08/21/2025. All fluids provided on the resident tray at mealtime and at the resident's bedside were re-evaluated and preferences were readdressed. Appropriate revisions were made to the care plan(s) to reflect current hydration interventions. The revised care plans were reviewed with staff involved in the care of the resident. 2) An audit of current residents' hydration risk evaluations was conducted on 08/20/2025 by the Director of Clinical Services, and Nurse Management team to verify a resident to be at risk for dehydration. Care plan reviews with intervention updated to include providing necessary assistance, encouragement, and offering of fluids throughout shift, as clinically indicated. 3) An in-service education was conducted on 08/19/2025 by the Administrator, Director of Nursing, or designee with all direct care staff addressing the significance of accurate reporting of fluids consumed during meals, the need to encourage fluid intake, and the provision of sufficient intake between meals to maintain adequate hydration. The in-service also addressed the importance of reporting conditions that alter a resident's fluid needs. 4) The nursing management team, Registered Dietitian, and/or Dietary Manager will review each resident with risk factors for dehydration to ensure appropriate interventions are implemented and an updated plan of care is complete. The Director of Nursing (DON), or designee, will complete five (5) random resident observations or resident and staff interviews on varying shifts and varying days weekly for fluid consumption for six (6) consecutive weeks and review all fluid intake records to ensure that appropriate interventions have been put in place to reduce the risk of dehydration. Audits will assure that care plans remain updated to reflect these interventions. The results of the audit will be forwarded to the Quality Assurance Committee for review monthly for at least three months with a goal of 100% compliance. Upon completion and 100% compliance for at least three months is achieved, the frequency of further review and ongoing need for review will be determined by the QAPI committee.