F0810

D

Failure to Provide Ordered Adaptive Eating Equipment

New Philadelphia, Ohio Survey Completed on 03-26-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide ordered adaptive eating equipment for a resident who required it. The resident was admitted with diagnoses including hypertensive urgency, renal dialysis, glaucoma, and legal blindness. A quarterly MDS assessment documented that the resident was independent in daily decision making but required set-up assistance for meals. Physician orders specified a renal diet with regular texture and thin liquids, double protein, several food restrictions, an 1800 milliliter fluid restriction, and the use of a blue scoop bowl and plate guard related to renal failure. During a supper meal observation, the resident’s meal ticket indicated the need for both a blue scoop bowl and a plate guard, but the tray was prepared with only a plate guard.

Further observations of subsequent meal tray lines showed that the required scoop bowl continued to be unavailable for the resident’s meals. At one lunch service, staff confirmed there were no scoop bowls available for the resident’s tray, despite the order specifying their use. Dietary staff interviews revealed that the facility previously had multiple scoop bowls but they could no longer locate them, and that only three had recently been available before they also went missing. Multiple staff, including dietary aides and the dietary manager, reported they were unable to find any scoop bowls in the kitchen, resident rooms, or on the units at the time of the observations. As a result, the resident did not receive the ordered adaptive equipment during the observed meals.