cms_WV: 865
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 865 | DUNBAR CENTER | 515066 | 501 CALDWELL LANE | DUNBAR | WV | 25064 | 2019-07-02 | 692 | E | 0 | 1 | LUON11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure that all residents maintained acceptable parameters of nutrition. This was true for four (4) of ten (10) residents reviewed for the care area of nutrition. Resident identifiers: #91, #92, #51 and #161, Facility Census: 117. Findings include: a) Resident #91 Medical record review for Resident #91, found the resident was admitted to the facility on [DATE]. [DIAGNOSES REDACTED]. Admission nursing assessment reviewed, no weight and/or height was obtained. Review of the admission MDS with ARD of 06/07/2019 under section K lists the weight as 128. Nutritional care plan for Resident #91 was initiated on 06/07/19 as follows: -- Focus: Resident is a potential nutritional concern related to (r/t) fair po (by mouth) intakes, [DIAGNOSES REDACTED]. -- Goal: No significant weight changes through next review. (MONTH) experience some weight fluctuations based on diuretic ([MEDICATION NAME]) treatment in place. --Interventions: Proheal (protein supplement) as ordered. Honor food preferences within meal plan. Weigh as ordered/needed and alert dietician and physician to any significant loss or gain. Monitor for changes in nutritional status (changes in intake, ability to feed self, unplanned weight loss/gain and abnormal labs) and report to food and nutrition/physician as indicated. Monitor intake at all meals, offer alternate choices as needed, alert dietician physician to any decline in intake. Provide diet as ordered Offer snacks. --On 06/08/19, a nutritional assessment for Resident #91, completed by the Registered Dietician (RD) with no weight and/or height recorded. Under nutritional history reads: .No height/weight available at time of assessment Review of Resident #91's weight and vitals summary found resident's height and weight was obtained on 06/11/19 at 6:35 pm. Weight 127.8 and Height 59 inches. Facility's weight and height policy reviewed and found: Patients are weighed upon admission and/or re-admission, then weekly for four (4) weeks and monthly thereafter. Patients height will be measured upon admission, re-admission, and annually and recorded in Point Click care (PCC). Purpose: To obtain baseline weight and identify significant weight change. To determine possible causes of significant weight change. To obtain baseline height. Interview on 07/02/19 at 11:10 am, with the Director of Nursing (DON) found the weight not obtained until ten (10) days after admission. She confirmed the resident's height and weight on admission and/or readmission should be obtained within 24 hours of admission/readmission. b) Resident #92 Medical record review for Resident #92, found the resident was admitted to the facility on [DATE]. [DIAGNOSES REDACTED]. Admission nursing assessment reviewed, no weight and/or height was obtained. On 06/06/19, a nutritional assessment for Resident #92, completed by the Registered Dietician (RD) with no weight and/or height recorded. Under nutritional history reads: .No height/weight available at time of assessment Nutritional care plan for Resident #92 was initiated on 06/07/19 as follows: --Focus: Resident is a potential nutritional concern related to (r/t) [DIAGNOSES REDACTED]. --Goal: No significant weight changes through next review. -- Interventions: Honor food preferences within meal plan. Weigh as ordered/needed and alert dietician and physician to any significant loss or gain. Monitor for changes in nutritional status (changes in intake, ability to feed self, unplanned weight loss/gain and abnormal labs) and report to food and nutrition/physician as indicated. Monitor intake at all meals, offer alternate choices as needed, alert dietician physician to any decline in intake. Provide diet as ordered Offer snacks. Review of Resident #92's weight and vitals summary found resident's height and weight was obtained on 06/12/19 at 1:25 pm. Weight 180.2 and Height 67 inches. Facility's weight and height policy reviewed and found: Patients are weighed upon admission and/or re-admission, then weekly for four (4) weeks and monthly thereafter. Patients height will be measured upon admission, re-admission, and annually and recorded in Point Click care (PCC). Purpose: To obtain baseline weight and identify significant weight change. To determine possible causes of significant weight change. To obtain baseline height. Interview on 07/02/19 at 11:10 am, with the Director of Nursing (DON) found the weight entered on Resident #92's not obtained until eleven (11) days after admission. She confirmed the resident's height and weight on admission and/or readmission should be obtained within 24 hours of admission/readmission. c) Resident #161 Record review at 9:00 AM on 06/26/19 found the Resident was admitted to the facility from the hospital on [DATE]. The resident was discharged from the facility on 05/13/19. The following weights were recorded in the facility's electronic medical record: 05/07/2019 10:37 175.0 pounds (Lbs.) 05/01/2019 15:07 174.8 Lbs 04/24/2019 17:14 186.0 Lbs 04/18/2019 13:14 186.0 Lbs 04/10/2019 16:47 191.2 Lbs The resident had a 8.47% from 04/10/19 to 05/07/19. The resident's admission minimum data set (MDS) with an assessment reference date (ARD) of 04/17/19 coded the resident as requiring extensive assistance of 1 staff member for eating. At 10:00 AM on 6/26/19, the administrator confirmed the facility does not document the daily percentage of fluid consumed by any resident. Review of the activities of daily living (ADL) record found the following days when no meal percentages were documented for the month of April, 2019: 4/12/19 -no documentation for dinner 4/14/19 no documentation for breakfast, lunch or dinner 4/15/19 no documentation for dinner 4/18/19 no documentation for dinner 4/20/19, no documentation for breakfast, lunch or dinner 4/21/19 no documentation for dinner 4/22/19 no documentation for breakfast, lunch or dinner 4/23/19 no documentation for dinner 4/24/19 no documentation for dinner 4/26/19 no documentation for dinner 4/27/19 no documentation for dinner 4/28/19 no documentation for dinner 4/29/19 no documentation for breakfast, lunch or dinner 4/30/19 no documentation for breakfast or lunch. May 2019 5/3/19 no documentation for dinner 5/4/19 no documentation for breakfast, lunch or dinner 5/5/19 no documentation for breakfast, lunch or dinner 5/6/19 no documentation for dinner 5/9/19 no documentation for breakfast or lunch 5/10/19 no documentation for breakfast, lunch or dinner 5/11/19 no documentation for breakfast, lunch or dinner 5/12/19 no documentation for breakfast, lunch or dinner The resident discharged to home on the morning of 5/13/19. On 07/01/19 at 2:05 PM, the dietary manager (DM) and the Regional dietary manager said they couldn't comment on why the facility was not monitoring the amount of meals consumed for a resident who was loosing weight. The DM said he wasn't employed at the facility at the time. The DM said he would call the registered dietician (RD). During a telephone call at approximately 3:00 PM on 07/01/19, the RD said she was aware the meal percentages where not being documented and she believed she talked to the MDS coordinator about the problem. The RD said she was concerned as it is important to know if the resident is eating the meals or refusing the meals. d) Resident #51 A review of Resident #51's medical record ar 3:22 p.m. on 07/01/19 found a nutritional assessment completed by the registered dietician (RD) on 05/07/19. Review of this assessment found the following notation under Section 9. Nutrition History: weight, diet, dining habits: Readmit/Weight Review: Diet: Regular/Liberalized with excellent po (by mouth) intakes recorded per ADL. Resident can feed self independently and make wants and needs known A review of the ADL flow sheets for Resident #51's meal intakes for 05/01/19 through 05/07/19 found Resident #51 only had meal percentages recorded for only four (4) of the 21 meals. The other 17 meals were left blank and no meal percentage was recorded. Despite this fact the RD noted that his meal percentages we excellent per the ADL flow record. Further review of the record found the following care plan related to his nutritional status: Focus Statement: Resident is a nutritional concern related to significant weight loss X 6 months and [DIAGNOSES REDACTED]. that may impact nutritional status. Goal Statement: No signficant weight changes through next review. Goal for Weight Maintenance. Interventions include: Monitor intake at all meals, offer alternate choices as needed, alert dietician and physician to any decline in intake. Further review of the ADL flow record from 05/01/19 through current found only 80 of the 183 meals for the two (2) months had a meal percentage documented. An interview with the Director of Nursing (DON) at 3:50 p.m. at 07/01/19 confirmed the residents meal percentages had not been consistently documented and the RD's assessment referred to good by mouth intake despite the fact that the majority of meals percentages were not documented. She agreed Resident #51' s parameters of nutrition could not be adequately monitored if his meal intake was not documented and monitored. | 2020-09-01 |