cms_WV: 9475
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9475 | OHIO VALLEY HEALTH CARE | 515181 | 222 NICOLETTE ROAD | PARKERSBURG | WV | 26104 | 2011-02-02 | 309 | D | 0 | 1 | U0V411 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and review of the facility's weight policy, the facility failed to provide care and services to attain or maintain the highest practicable physical well-being for one (1) of thirty-seven (37) Stage II sample residents. Resident #44 had a significant change in condition for which there was no evidence to reflect facility staff identified this change and/or notified the resident's attending physician and/or responsible party. The resident experienced an eleven (11) pound unplanned weight loss, representing a loss of 11.7% of her total body weight, in a 10-day period. There was no evidence of review of existing weight loss interventions and/or new interventions by the physician and/or other members of the interdisciplinary team to address this change in condition. Resident identifier: #44. Facility census: 63. Findings include: a) Resident #44 1. Record review revealed this [AGE] year old female resident was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. The resident was recently hospitalized from [DATE] through 01/13/11 for an irregular heart rate. Resident #44, when readmitted to the facility on [DATE], weighed 94#. On 01/22/11, she again weighed 94#. On 01/28/11, the resident weighed 86#; this represented an 8# (8.5%) weight loss over a 6-day period. On 01/29/11, the resident weighed 84#, representing a 10.6% weight loss in seven (7) days. On 02/01/11, the resident was weighed at the surveyor's request, and the resident's weight was 82.8#, a loss of 11.7% in a ten (10) day period. -- 2. Review of the resident's nursing notes revealed the following entries: - On 01/14/11 at 8:34 p.m. - . ate poorly at dinner - took evening snack. - On 01/19/11 at 11:58 a.m. - . Of her 1800 ADA pureed with nectar liquid diet res (resident) ate an average of only 20.1% over last 7 days. Does not take supplements well. Weight on 1/14/11 was 93.4 lbs. - On 01/20/11 at 11:06 a.m. - . Taken to dining room to eat - encouraged to feed self - declined. Assist x 1 for feeding. - On 01/26/11 at 11:11 a.m. - . of her 1800 CAL pureed with nectar liquid diet Res ate ave (average) of 27%. Weight on 1-22-11 was 94%. - On 01/28/11 at 1:45 p.m. - Skilled for PT/OT. Wt 86 lbs. No s/s (signs / symptoms) distress noted. Continues to have poor PO (oral) intake. Up in w/c (wheelchair) for meals in dr (dining room) and is fed per staff. - On 01/29/11 at 12:20 p.m. - Resident was a Re WT (re-weigh) today. WT 84.0 lbs. Skilled for PT/OT. - On 01/30/11 at 11:17 a.m. - .Resident up to W/C for meals with assist of x 2 staff. PO Intake remains poor. Resident refuses any supplement or snack. - On 01/30/11 at 8:11 p.m. - Res was screened for ST (speech therapy) on 1-18-11 Post hospitalization . Res on diet of puree with nect liq and continues to tolerate current diet level. No changes at this time. - On 01/31/11 at 12:28 p.m. - 3rd Weekly Pressure Risk Eval completed. High score of 23 unchanged. Labs reflect a TLC of 769.3 on 01/12/11. Of her 1800 CAL ADA Pureed diet with Nectar liquids Ave intake over last 7 days was 35.2 %. 1-29-11 weight was 84.0 lbs. No documentation was found in the record to reflect efforts by staff to notify the resident's attending physician or responsible party of this weight loss. -- 3. Observation of this resident, in the dining room during the noon meal on 01/31/11, found a nursing assistant (Employee #55) feeding the resident. When asked, Employee #55 said that, since the resident had been sick, her ability and desire to eat had decreased. -- 4. Review of Resident #44's 14-day Medicare assessment (version 3.0), with an assessment reference date of 01/27/11, found the assessor noted in Section K0300 that the resident had a Loss of 5% or more in the last month or loss of 10% or more in last 6 months. The assessor encoded 2 to indicate the resident was on physician prescribed weight-loss regimen. The resident's height was 57 inches, and the resident's weight was listed at 94#. -- 5. Review of the resident's most recent care plan for nutrition, dated 01/05/11, identified the following problem statement: Needs Low concentrated sweet NAS (no added salt) puree diet with nectar fluids. Was pocketing food on previous consistency. Diet snack tid. Able to make food preferences know if asked. Needs seated at supervised table to assist with eating needs encouraged. Wt. loss in past 180 days. The goal associated with this problem stated: Resident will try to consume at least 50% of meals and take snacks tid to try to help bs (blood sugar) be wnl (within normal limits) and try to prevent wt loss by next quarter. Interventions included: Offer Diabetic snack tid as ordered; Monitor weight; Monitor food intakes tid to assure adequate nutrition; Needs seated at assist table to try to encourage adequate at meals and feed if necessary. -- 6. Review of the resident ' s physician orders found an order, dated 01/13/11, for an 1800 calorie ADA pureed diet with nectar liquids and weekly weights for five (5) weeks. Review of the physician's progress notes found an entry dated 01/24/11, noting the resident's weight was 93.4# and she was eating 32% of meals. There were no changes to the plan of care (POC) regarding the resident's nutritional status. Another entry, dated 01/26/11, indicated the resident's weight was 94# and stated, Res doing well. Drowsy today. The plan of care stated, Cont (continue) current POC. Stable. -- 7. In an interview on 02/01/11 at 11:30 a.m., the dietary manager (Employee #9) indicated she was unaware of the resident's weight loss. Review of the dietary progress notes and assessments found no mention of the resident's weight loss or of dietary interventions implemented in an effort to reverse the loss. A request was made for the resident's meal intake records for January 2011 and copies of dietary assessments and notes. The most recent entry in the dietary progress notes, dated 01/06/11, stated, Resident needs assisted to meals and seated in assisted dr (dining room). She is eating 66% of meals and receives a low concentrated sweet ns (no salt) pureed diet with nectar fluids. Wt. 96 lbs. She receives a diabetic snack tid (three-times-daily). The Diet History - Annual, dated 11/26/10 and signed by the dietary manager, indicated the resident was eating 61% of meals and the resident's weight was 99#. The history also indicated the resident had a slow weight loss and her weight one hundred eighty (180) days prior was 106#. The dietary manager provided two (2) Meal Intake Detail Reports. Comparison of the Meal Intake Detail Report for this resident found, for the dates of 12/29/10 through 01/05/11, the resident's intake averaged 74.14% for breakfast, 49.29% for lunch, and 65% for dinner, with an average daily total meal intake of 62.91%. For the dates of 01/25/11 through 02/01/11, the resident's intake averaged 41.50% for breakfast, 38.13 % for lunch, and 30.00% for dinner, with an average daily total meal intake of 36.68%. -- 8. On 02/01/11 at 1:30 p.m., the DON confirmed the physician had not been notified of Resident #44's weight loss, and she presented a fax sent to the physician regarding the resident's weight loss dated 12:13 p.m. on 02/01/11. -- 9. Subsequent review of the resident's record found the following entries in the nursing notes: - On 02/01/11 at 1:20 p.m. - Monthly weight is 82.4 pounds and decrease of 1.2 pounds from last weight has lost 11.2 pounds from 1/22/11. Faxed out to Dr. (name). Tried to speak with (name) daughter via phone to inform not at home and has no answering machine. - On 02/01/11 at 6:32 p.m. - . At 2:30 p.m. Dr. (name) informed of weight loss. Refuses to assist self. Fed dinner - ate approx 25% - Declined to eat more. Max assist for transfers and bed mobility. - On 02/01/11 at 8:53 p.m. - New order per Dr. (name). Change diet to regular diet as tolerated. Resident will continue pureed with nectar thickened liquids - snacks TID. Attempted to contact (name), POA (power of attorney) - No answer. Dietary Informed. Subsequent review of the resident's physician orders found an order, dated 02/01/11 at 08:30 p.m., changing the resident's diet order to regular pureed with nectar liquids and snacks three (3) times a day. -- 10. Review of the facility policy for Weights, received from the DON on 02/01/11 at 2:00 p.m., found: If there is a weight change of 5 or more pounds, either loss or gain, a re-weigh will be done the following day. The physician and MPOA will be notified of the weight change. Restorative nursing assistants will obtain the weight, document weight in Care Tracker, and notify the assigned nurse. The nurse will document the weight on the flow sheet in the nurses' notes and notify appropriate contacts. There was no evidence to reflect staff followed this policy for Resident #44. | 2015-11-01 |