Failure to Provide Sufficient Hydration to Dependent Resident
Penalty
Summary
A deficiency was identified when a resident with mild cognitive impairment and a documented risk for hydration concerns was not provided with sufficient fluids to meet her assessed needs. The facility's policy required processes to ensure adequate hydration, but records showed the resident consistently received less than the recommended 1500 mL of fluids per day, with intake ranging from 140 mL to 540 mL on documented days. The resident was dependent on staff for assistance with eating and drinking, and her care plan reflected this need. Despite family concerns and requests for IV fluids due to poor oral intake, the facility delayed intervention pending lab results and did not initiate supplementation until after a nutrition assessment indicated malnourishment. The order for a nutritional supplement was not implemented until a day after it was recommended, and there was no evidence that the facility monitored the amount of supplement consumed or tracked total fluid intake as required. Interviews with staff and family confirmed that the resident required assistance with feeding and that her intake was inadequate. The registered dietitian and nursing staff acknowledged that the resident's fluid intake was below the minimum threshold for adequate hydration, and documentation practices did not ensure accurate monitoring of supplement or fluid consumption. The resident was ultimately sent to the hospital after a fall and did not return to the facility. The deficiency was reviewed with facility leadership during the exit conference.