Failure to Provide and Monitor Nutrition and Hydration for Residents
Penalty
Summary
The facility failed to implement a comprehensive, resident-centered treatment plan to address the nutritional needs of residents requiring enteral nutrition and did not maintain appropriate parameters to accurately assess nutritional status. For one resident with a history of nontraumatic intracerebral hemorrhage, type II diabetes, and dysphagia, the medical record showed that the resident was ordered nothing by mouth and relied solely on enteral nutrition via Osmolite 1.5. On a specific date, documentation indicated that the prescribed enteral nutrition was not administered because it was reportedly unavailable, and there was no evidence that the physician or registered dietician was notified of the missed administration. Subsequent interviews revealed confusion regarding staff identity and documentation, with conflicting accounts about whether the nutrition was actually given, and no supporting documentation to confirm administration. Another resident, admitted with multiple diagnoses including osteoarthritis, hypertension, diabetes, and neurocognitive disorder, was identified as being at risk for malnutrition. The care plan required weekly weights for four weeks to monitor nutritional status. However, the medical record did not contain evidence that the resident was weighed after the initial entry, despite a clear order and facility policy requiring weekly weights to establish a baseline. The DON confirmed that the required weekly weights were not performed as ordered. Facility policy for enteral tube feeding required documentation of any problems or complications, including practitioner notification and prescribed interventions, and the weight policy mandated weekly weights for new admissions. In both cases, the facility failed to follow its own policies and physician orders, resulting in a lack of proper monitoring and documentation for residents' nutritional needs.