Failure to Provide Ordered Adaptive Eating Devices During Meals
Penalty
Summary
Surveyors observed that the facility failed to provide adaptive eating devices as ordered for two residents during a meal. One resident, who had a physician's order and care plan specifying the use of a sip-a-mug for her regular diet, was not provided with the sip-a-mug during dinner. This was confirmed by a nurse aide, who was unsure if the order for the sip-a-mug was still active. The resident's care plan also indicated she was at increased nutritional risk due to multiple medical conditions, including ETOH abuse, COPD, cerebral aneurysm, advanced age, and significant recent weight loss, and required cues to eat and encouragement to consume adequate nutrition and fluids. Another resident was observed receiving his drink in a sip-a-mug cup, while his tray card, order, and care plan specified a different adaptive device, a [NAME] Cup. The DON later stated that the order had been changed to a sip-a-mug the previous day. The facility's policy required that assistive devices and utensils be provided as identified in the individualized plan of care to maintain or improve a resident's ability to eat or drink independently. These observations were confirmed with the DON.