Failure to Provide Ordered Double Portions and Nutritional Supplements
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered therapeutic nutrition interventions, including double portions and prescribed nutritional supplements, to a resident with multiple high-risk diagnoses. The resident was admitted with dehydration, diabetes mellitus, a stage 4 sacral pressure ulcer, dementia, dysphagia, and was care planned as needing partial to moderate assistance with eating due to an ADL self-care deficit. Physician orders specified a NAS/LCS mechanical soft diet with Mighty Shakes at breakfast and lunch with double portions, Med Pass twice daily, and bedtime snacks, as well as notification of the primary physician for significant weight changes. The facility’s policy on Interventions for Unintended Weight Loss required identification and monitoring of individuals with unintended or insidious weight loss so that appropriate interventions could be implemented. On multiple observations, the resident did not receive the ordered double portions or nutritional supplements, and staff did not provide the level of feeding assistance identified in the care plan. During breakfast and lunch observations, the resident’s meal trays lacked the ordered supplements, and the entrees were served as regular portions instead of double portions. The resident’s niece reported repeated concerns to staff about the resident’s weight loss and stated that staff were not assisting with feeding, not providing double portions, and not supplying ordered nutritional supplements; she also indicated that the protein shake at the bedside was brought in by family and that a milkshake ordered with breakfast was not provided. A CNA stated there was no need to assist the resident with feeding because he was independent, which conflicted with the care plan indicating a need for partial to moderate assistance. The resident was later hospitalized with an admitting diagnosis of failure to thrive and severe malnutrition with muscle wasting, which was confirmed by the hospital RN.
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