Failure to Provide Consistent Overnight Hydration
Penalty
Summary
The facility failed to ensure that residents consistently received water and other fluids in accordance with their needs and preferences, resulting in insufficient hydration support. Resident council minutes indicated that residents were not provided with ice or water between 11:00 PM and 7:00 AM. A review of a complaint also revealed concerns about the lack of water provision. During nighttime observations, staff were seen delivering water starting around 5:00 AM, but several residents were found with empty or nearly empty water cups, some of which were not dated or contained beverages from the previous day. These findings were confirmed by staff present during the observations. Interviews with the Administrator and DON revealed that there was no consistent procedure in place to ensure water was distributed to residents throughout the night. The DON believed new water cups were distributed around 5:00 AM, while the Administrator thought they were provided at the beginning of the night shift. The lack of a standardized process led to residents not having adequate access to water during overnight hours, as evidenced by multiple observations and resident reports.