F0692

D

Failure to Provide Ordered Double Portions, Meal Assistance, and Hydration

Pickerington, Ohio Survey Completed on 01-20-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide adequate nutrition as ordered for one resident and insufficient meal assistance and hydration for another. One resident with multiple complex diagnoses, including severe protein malnutrition and significant weight loss, had a care plan indicating increased caloric and nutrient needs and physician orders for an appetite stimulant and nutritional supplement. This resident reported she was supposed to receive double portions at meals but stated she did not receive them. During a breakfast observation, she had a cinnamon bagel with cream cheese and two servings of cereal, and she stated she preferred a different cereal. At lunch, she was served a single portion of chicken and dumplings soup, carrots, and Jello; the Executive Director confirmed she was not given double portions and that her meal ticket did not indicate a double-portion order.

The second resident had diagnoses including dementia, cerebrovascular disease, diabetes, and muscle weakness, and was care planned as at risk for malnutrition with interventions to assist with meals, offer alternate food and beverages as needed, and provide diet and supplements as ordered. The MDS showed the resident required tray setup for eating and was dependent on staff for all ADLs, with no documented refusals of care. Meal percentage records showed no morning or bedtime snacks documented over a two-week period, despite a facility policy stating a nourishing bedtime snack would be provided. Observations over several days showed the resident receiving meals such as hot dogs and ham but struggling to cut food, with covered fruit cups and rolled silverware left unopened, and staff not consistently assisting with setup or cutting food as needed.

Multiple observations documented that this resident’s meal trays and fluids were frequently placed out of reach and not adjusted so he could eat or drink independently. On several occasions, he was seen semi-lying or lying in bed with the tray to the side and out of reach, or in a dining area without fruit or water available, and his water cup was observed empty and pushed against the wall out of reach. Staff interviews revealed that dietary staff sometimes waited to see if residents would open their own items before assisting, and CNAs reported they gave water primarily to residents who could ask for it and that there was no water cart. The Assistant Director of Health Services confirmed the expectation that trays should be placed in front of residents and food cut up if needed, and also confirmed there was no facility hydration policy, while the Director of Health Services stated all residents are offered a bedtime snack. The resident reported he did not like hot dogs and was not offered an alternative, despite facility policy requiring an appropriate alternate when food is not accepted and substitutions for residents consuming 75% or less, and staff were expected by policy to assist individuals as needed.