Failure to Intervene After Resident Meal Refusals
Penalty
Summary
The facility failed to ensure that a resident received adequate nutrition by not providing appropriate interventions when the resident refused multiple meals. The resident, who had diagnoses including diabetes, dysphagia, lack of coordination, and an above-knee amputation, was admitted with a care plan that identified a risk for nutritional problems and required a mechanical soft, carbohydrate-controlled, no added salt diet. The care plan specified that the resident should maintain adequate nutritional status by consuming at least 75% of three meals daily, and included interventions for the registered dietitian to evaluate and make dietary recommendations as needed. Despite these care plan requirements, documentation showed that the resident refused to eat dinner on one day and refused all meals on two other days. There was no evidence that the physician or registered dietitian were notified of these refusals, as required by facility policy. The DON confirmed during interview and record review that there was no documentation of such notifications, and acknowledged that the physician and RD should have been informed immediately to provide recommendations. Facility policy required notification of the physician and responsible party in cases of resident refusal of care or services, but this was not followed.