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F0692
D

Failure to Provide Required Sack Lunches for Dialysis Resident

Loma Linda, California Survey Completed on 07-03-2025

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

Staff failed to provide required nutritional services to a resident dependent on dialysis, as the resident was not consistently given a sack lunch to take to dialysis appointments on multiple occasions. The resident, who had chronic kidney disease, anemia, and sepsis, reported not receiving a sack lunch on several dialysis days and sometimes missing breakfast as well. Review of the facility's records confirmed that on several documented dates, the resident was not provided a sack meal for dialysis, despite physician orders specifying a renal diet and nutritional supplements. The facility's policy required notification of dietary staff for sack lunches on dialysis days and monitoring of special diets, but this was not followed. The DON acknowledged that a physician's order for a sack lunch should have been obtained at admission but was not. The resident experienced a 5.17% weight loss over a three-month period, as documented in the clinical record, during the time when sack lunches were not consistently provided.

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