Failure to Consistently Provide Beverages to Residents
Penalty
Summary
The facility failed to consistently provide beverages to residents in accordance with their needs and preferences, resulting in multiple instances where residents did not have access to water or other drinks. Several residents, including those with significant medical conditions such as acute kidney failure, urinary tract infections, epilepsy, and cirrhosis of the liver, were identified as being at risk for dehydration and required assistance with personal care. Despite care plans indicating a risk for dehydration, residents and their family members reported that water and ice were not regularly passed out, and at times, residents were left without any drinks in their rooms. Observations confirmed that some residents did not have water or cups within reach, and staff interviews corroborated that the distribution of drinks was inconsistent. Multiple staff members, including CNAs and an agency LPN, acknowledged that water and ice were not always provided, citing staffing issues as a contributing factor. Resident council minutes and concern forms documented repeated complaints about the lack of drink distribution, with some residents stating they had to request water from night staff or that staff became upset when asked for drinks other than water. The facility had previously conducted an in-service on passing water and snacks, but there was no evidence of follow-up to ensure compliance. The deficiency had the potential to affect all 52 residents residing in the facility.