Failure to Provide Adequate Hydration to Residents
Penalty
Summary
The facility failed to ensure adequate hydration for two residents, as required by facility policy and each resident's care plan. Observations and interviews revealed that both residents did not have fluids available at their bedside, despite having no fluid restrictions and being identified as at risk for dehydration. Staff, including licensed nurses and certified nurse assistants, confirmed the absence of fluids and acknowledged that fluids should have been available and within reach at all times. Both residents' care plans and hydration risk assessments specifically included interventions such as keeping fluids in reach, encouraging oral fluid intake, and monitoring for signs and symptoms of dehydration. As a result of these failures, one resident exhibited dry mucous membranes, chapped lips, and dry, peeling skin on the left leg, while the other resident had dry mucous membranes, chapped and cracked lips, and concentrated dark amber urine. Staff interviews confirmed these were signs and symptoms of dehydration and, in one case, increased risk for urinary tract infection due to the presence of an indwelling catheter. The Director of Nursing stated that it was the facility's expectation for residents to always have fluids available and within reach, and that the process required CNAs to provide fresh fluids at the beginning of each shift and with each meal.