Failure to Provide Adequate Nutritional Support and Assistance During Meals
Penalty
Summary
A resident with a history of neurological and cognitive impairments, including corticobasal degeneration and parkinsonism, experienced significant weight loss over a six-month period. The resident's care plan identified her as being at nutritional risk and outlined specific interventions, such as providing cueing and reminders during meals, offering preferred foods, and using adaptive equipment. Despite these documented needs, the resident did not consistently receive the required cueing or supervision during meal times, as observed by the surveyor and confirmed through staff interviews. Meal intake records showed that the resident consumed 50% or less of her meals nearly half the time, and observations revealed frequent difficulties with self-feeding, including dropping food and struggling to use utensils due to physical limitations. The facility's policy required that residents with inadequate oral intake be offered nutritional supplements and that physician orders for nutrition support be communicated to the nutrition services department. Although the registered dietician recommended a nutritional supplement (Ensure) to address the resident's ongoing weight loss, there was no evidence that an order for the supplement was placed or that it was included on the resident's meal card. Staff interviews indicated confusion regarding the process for implementing dietician recommendations and placing supplement orders, with the DON unsure about the current protocol. Further, staff interviews and observations revealed that CNAs were not always present in the dining room at the start of meals to provide necessary assistance, as they were occupied with other duties. Dietary aides were not permitted to assist with feeding or cueing, and CNAs reported that the resident often refused built-up utensils and required increasing assistance with eating. Despite these challenges, there were no documented changes to the resident's nutritional care plan or additional interventions implemented in response to her declining intake and weight loss.