F0655

D

Baseline Care Plan Omitted Enhanced Barrier Precautions for Tube-Fed Resident

Weslaco, Texas Survey Completed on 03-03-2026

Penalty

No penalty information released

Summary

Surveyors identified a failure to develop and implement a complete baseline care plan within 48 hours of admission for one resident, specifically omitting enhanced barrier precautions (EBP) despite the presence of an indwelling device. The resident was an older male admitted with multiple diagnoses including cerebral infarction, metabolic encephalopathy, dysphagia, cognitive communication deficit, muscle wasting and atrophy, and gastrostomy status, and had a BIMS score of 4 indicating severe cognitive impairment. The MDS reflected use of a feeding tube on admission, and the order summary showed an active enteral feeding order with Glucerna 1.5 via feeding tube at a specified rate every shift. The baseline care plan documented that the resident required tube feeding and was dependent for tube feeding and water flushes, but directed staff to see orders for current feeding orders and did not include EBP.

Interviews with facility leadership confirmed that the resident required EBP from admission due to the feeding tube being considered an indwelling or invasive device. The DON stated that the baseline care plan was completed within 48 hours and that she reviewed and signed it, but acknowledged that the section asking whether the resident required special precautions was marked “no,” resulting in EBP not being reflected on the baseline care plan. The ADON and ADM both stated that residents with feeding tubes should have EBP noted on the baseline care plan and that EBP should have been included for this resident. The facility’s Baseline Care Plans policy required development and implementation of a baseline care plan within 48 hours of admission that includes the minimum healthcare information necessary to properly care for a resident, but the omission of EBP from the resident’s baseline care plan did not meet this standard.