F0684

E

Failure to Perform Nutrition-Focused Physical Assessments for Dialysis Residents

Van Nuys, California Survey Completed on 03-12-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that Registered Dietitians (RDs) conducted nutrition-focused physical assessments, including direct interaction with residents or their representatives, for residents receiving hemodialysis. Resident 1 was admitted with ESRD, type 2 DM, moderate protein-calorie malnutrition, and dependence on hemodialysis. The care plan for Resident 1 identified risk for nutritional problems related to chronic kidney disease, ESRD, DM, and malnutrition, and included an intervention for the RD to evaluate and make diet change recommendations as needed. The facility’s process, as described by the Dietary Supervisor (DS), was that within the first three days of admission the DS interviews the resident for food preferences, and then the RD completes the second part of the evaluation and writes recommendations based on the DS’s information.

Surveyors found that RD 1, who worked remotely, completed Nutrition Evaluation and RDN Reviews without conducting face-to-face assessments or speaking with residents or their families/representatives. RD 1 stated that she relied on the DS’s information and her own education and did not need to perform in-person assessments. For Resident 1, the Nutrition Evaluation and RDN Review were completed based on record review and DS input, without RD 1 physically assessing the resident or directly interviewing the resident or representative. The DON confirmed that RD 1 worked remotely and that RD 2 was expected to check and assess newly admitted residents, but also stated that, in the DON’s view, it was acceptable for RD 1 to assess residents remotely through thorough record review.

For Resident 2, who was also on dialysis and considered high risk, RD 2 acknowledged that the resident should have been seen and evaluated in person but had not been assessed because the resident was off-site for dialysis on the day RD 2 was in the facility. RD 2 stated that RD 1 had assessed Resident 2 and documented the Nutrition Evaluation and RDN Review, again without an in-person assessment. RD 2 did not answer when asked about standards of practice for RDs or what a nutrition-focused physical assessment entails. The facility’s policies and job descriptions, as well as the Academy of Nutrition and Dietetics’ Nutrition Care Process documents reviewed by surveyors, emphasized assessing nutritional status through interview, observation, and physical assessment, and collaborating with the client in developing goals and monitoring outcomes, which contrasted with the facility’s practice of remote, record-based RD assessments for these residents on hemodialysis.