Failure to Address Significant Weight Gain and Nutritional Status
Penalty
Summary
The facility failed to recognize and respond to a significant weight gain in a resident, resulting in a lack of interventions to maintain acceptable nutritional status. The resident, who was cognitively intact and had diagnoses including hypertension, peripheral vascular disease, hyperlipidemia, asthma, and diabetes, was admitted at 165 pounds and later recorded at 231 pounds, reflecting a 35.8% increase in weight. Despite an order for a diabetic, regular textured diet, the resident's electronic medical record showed no follow-up or intervention from dietary or nutrition services regarding the substantial weight gain. The most recent nutrition data noted the weight increase but did not include any interventions, only indicating that the registered dietician would follow up as needed. Interviews revealed that the resident expressed concerns about the quality and appropriateness of the food provided, stating it was not suitable for a diabetic diet and that no dietician had addressed her weight gain or dietary concerns. The dietary manager acknowledged awareness of the resident's complaints but had not discussed the weight gain with the resident, citing the resident's right to choose their food. A licensed practical nurse confirmed the significant weight gain and noted that the dietician typically monitored nutritional status but had not followed up in this case. Facility policy required evaluation and intervention for undesirable weight changes, but this process was not followed for the resident.