Lack of RD Oversight in Nutritional Management
Penalty
Summary
The facility failed to ensure proper oversight and supervision by the Registered Dietician (RD) of the Dietary Technician (DT) for a resident who was at increased risk for unintended weight loss. The resident, who had a history of stroke with left side paralysis, difficulty swallowing, and dementia, was admitted with severe cognitive impairment and total dependence for feeding. The care plan identified the need for a mechanically modified diet, assistance with meals, and supervision due to pocketing food. Despite these interventions, the resident's oral intake remained less than 50%, and she refused oral nutritional supplements, with fortified foods being added as an alternative. The resident experienced a significant weight loss of 6.7 pounds in one week. Observations revealed that the resident was often left without staff assistance at mealtimes, resulting in minimal food consumption. Interviews with staff indicated that the DT, rather than the RD, completed the admission nutritional assessment and made changes to the resident's care plan without the RD's awareness. The RD confirmed she was not informed about the resident's high-risk status or the weight loss, and that she typically reviews high-risk assessments with the DT but was not involved in this case. This lack of RD oversight and communication contributed to the failure to maintain the resident's nutritional status.