Failure to Provide Adequate Fluids to Dependent Resident
Penalty
Summary
Surveyors identified that the facility failed to provide adequate fluids to maintain hydration for one dependent resident. Over multiple observations on consecutive days, the resident was repeatedly seen seated in a reclining wheelchair in the common area and in her room without any fluids available nearby. During the morning hours, no water or other fluids had been passed to the resident in her room or in the common area, and by late morning the resident remained without access to fluids. During a lunch dining observation, a CNA fed the resident a liquid diet meal that included broth, yogurt, a magic cup, a mighty shake, pudding, and juice, and the resident’s family took over feeding during the meal. The CNA reported that she had not given the resident any fluids between breakfast and lunch. The resident’s family member reported that staff had not “pushed fluids,” which they believed led to a recent hospitalization for dehydration and elevated sodium levels, and that family members came daily to feed the resident because staff did not feed or offer enough fluids. The family member stated that when they were unable to visit due to illness, the resident became dehydrated, and that the facility continued not to offer fluids even after the resident returned from the hospital. Record review showed the resident had multiple diagnoses including Alzheimer’s disease, dementia, acute kidney failure, and signs and symptoms concerning food and fluid intake. A recent ED note documented that the resident was admitted with severe dehydration, dry oral cavity, and significantly abnormal labs, including sodium of 170 and potassium of 3.0, and was treated with IV fluids. The resident’s care plan identified dehydration or potential for fluid deficit related to diuretic use, with an expectation that the resident would be free of dehydration symptoms, and the facility’s hydration policy required offering sufficient fluids to maintain proper hydration and health.
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