Failure to Implement Hydration and Nutrition Care Plan Interventions
Penalty
Summary
The facility failed to implement care plan interventions for a resident with significant medical needs, including Alzheimer's Disease, dysphagia, diabetes, abnormal weight loss, and congestive heart failure. The resident was assessed as having severe cognitive impairment and required total assistance with eating. The care plan specified that the resident should have access to cool, fresh water at the bedside and receive snacks at 10:00 AM and 2:00 PM due to ongoing weight loss. Observations revealed that the water pitcher was repeatedly placed out of the resident's reach, and staff did not ensure the resident had access to water as required by the care plan. Additionally, staff did not provide the necessary assistance during meals, as a CNA set up the meal tray and encouraged the resident to eat but did not remain to provide further help or encouragement. The resident was also observed attempting to eat breakfast without staff present to assist, despite needing total assistance. Interviews with staff confirmed that the resident had not received the scheduled snacks and that the care plan interventions were not being followed as required.