Failure to Provide Adequate Hydration Assistance
Penalty
Summary
The facility failed to ensure sufficient fluid intake for residents by not providing fresh, easily accessible water at bedside, and not assisting or cueing residents who required help with hydration. Observations and interviews revealed that multiple residents who were dependent on staff for activities of daily living, including drinking, had water placed out of their reach and did not receive regular assistance or offers of fluids. One resident was observed with cracked and peeling lips, unable to reach or hold a water cup, and reported not being offered water or assistance despite being very thirsty. Another resident, also fully dependent, stated that while water was filled, staff did not offer drinks between meals or at night, and the water cup was placed where the resident could not access it without help. A third resident, who required some assistance with ADLs but could feed themselves, also had water placed far out of reach. Staff interviews confirmed that while there was an expectation for CNAs to offer water during every room entry and bed check, this was not consistently happening. A registered nurse reported having raised concerns about CNAs not performing hydration duties to management multiple times, with no resulting change. The DON was unaware of the hydration issues and stated that staff should be offering fluids regularly to those unable to drink independently. Medical records showed that one resident was sent to the emergency department with severe dehydration and a urinary tract infection, returning with ongoing issues. Care plans for the affected residents indicated their dependence on staff for hydration and risk for dehydration, but observations and interviews demonstrated that these needs were not being met. Documentation and care plans lacked specific instructions regarding assistance with drinking, contributing to the deficiency.