cms_HI: 71
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 71 | HALE MAKUA - KAHULUI | 125007 | 472 KAULANA STREET | KAHULUI | HI | 96732 | 2019-11-26 | 692 | D | 0 | 1 | 6SOG11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview with resident and staff members, the facility failed to ensure 1 of 3 residents was monitored for weight loss. The system for reporting significant weight loss for a resident receiving daily weights was not established; therefore, the resident was not assessed by a Registered Dietitian (RD). Also, the facility failed to develop a care plan to address weight loss related to the resident's [MEDICAL CONDITION] and use of diuretics. Findings include: Resident (R)209 was admitted to the facility on [DATE] with the following Diagnoses: [REDACTED]. On 11/19/19 at 2:30 PM an interview was done with R209. R209 reported loosing weight, approximately 4 to 5 pounds. Further inquired whether she was on a special diet, she replied no. Observation also found R209's lower extremities were mottled with red spots and appeared to be swollen. R209 reported she fell at home and the red spots were the result of [MEDICAL CONDITION] crawling on the carpet. On 11/20/19 at 09:15 AM R209 was observed sitting outside of her room and had eaten all her breakfast. R209 stated breakfast is the best meal. Record review found the following weights for R209: 166 (11/01/19); 163 lbs. (11/06/19); 159 lbs. (11/13/19); 153 (11/14/19); 148 (11/19/19); 145 (11/21/19) and 143 (11/25/19). On 11/01/2019, the resident weighed 166 lbs. and on 11/25/2019, the resident weighed 143 pounds which is a 14% weight loss in less than a month. A review of the physician's orders [REDACTED]. twice daily for generalized [MEDICAL CONDITION]. The admission Minimum Data Set with an assessment reference date of 11/06/19 notes R209 did not have a weight loss and indicates R209 received diuretics during the assessment period. A review of the Comprehensive Nutritional Assessment, signed 11/11/19 notes the following diet recommendations: 3 gram sodium; regular texture; and fluid restriction. R209 also noted to have fair to good intake at meals with 2+ [MEDICAL CONDITION]. The assessor also notes R209 had slight weight loss since admission suspected due to fluid. A subsequent Mini Nutritional assessment dated [DATE] notes R209's food preferences and a plan to weigh the resident daily prior to breakfast. R209's care plan was reviewed on 11/22/19 at 11:11 AM. The goals include: maintaining stable weights (+/- 5% admission weight, ideal body weight 112.5 lbs.) and labs; being free of signs and symptoms of constipation and dehydration; and maintaining the best quality of life by being well nourished. On 11/26/19 at 08:39 AM a copy of the care plan was provided by the facility. A review of the document found the goal of maintaining stable weights was discontinued (no date documented of when this goal was discontinued). In addition the goal of loosing weight due to [MEDICAL CONDITION] and [MEDICATION NAME] treatment was added to the care plan. There is no documentation of the date this goal was added to the resident's care plan. On 11/25/19 at 10:05 AM an interview was done with the Neighborhood Supervisor (NS)1. Inquired whether the Registered Dietitian (RD) was notified of R209's weight loss. NS1 reported weights are sent to the RD weekly (Saturdays) and based on the calculated percentage of loss or gain, this would trigger the need to do a comprehensive review and consult the RD. NS1 reported R209 receives [MEDICATION NAME]; therefore, weight loss was expected. On 11/26/19 at 07:20 AM an interview and concurrent record review was done with the Dietitian Coordinator (DC). The DC reported R209's record regarding the weight loss was reviewed. Inquired when was she informed of the resident's weight loss, DC replied yesterday (11/25/19). The DC reported R209 had a planned weight loss, inquired whether this was included in the resident's care plan, the DC reported she would check on this. Concurrent record review found no care plan related to a planned weight loss. The DC further explained R209 was [MEDICAL CONDITION] and on [MEDICATION NAME] so the weight loss was expected. Further queried how to determine whether the loss is attributed to fluid loss or a true weight loss. The DC reported even if a weight loss is expected the nursing staff needs to report the loss to the dietitian. The DC clarified R209 is on daily weights and there may have been a glitch in the new system as this resident was not included in the weight reports. The system supports reports for residents on weekly and monthly weights but not daily weights. Therefore, R209's weight loss was not triggered. The DC explained the process entails nursing to upload weights in the electronic medical record (EMR) and the report is received by the dietitians on Saturday. Staff members are required to report a 2% weight loss in a week to the dietitian, physician and as applicable the resident's representative. Also, a reportable is a 5% weight loss in a month. The DC provided an update for R209 which was dated 11/25/19. The note documents R209's weight as 143.4# on 11/25/19, 147.6# on 11/18/19, and 161.8# on 11/11/19 which reveals a 2.8% decrease in one week (between 11/18/19 to 11/25/19) and 9% decrease (11/11/19 and 11/18/19). A review of the meal intake found the resident's food intake at meals ranges from 50-100% and R209 meets the daily fluid intake. Also noted R209 received [MEDICATION NAME] intravenously, continues on oral diuretic ([MEDICATION NAME]) and has +1 [MEDICAL CONDITION] to bilateral lower extremities. The DC notes it is suspected the weight loss is mainly due to fluid as the resident has had fair to good intake since admission. There is an expectation of continued weight loss. The plan is for nursing to notify the dietitian of weekly significant weight changes. On 11/26/19 at 08:39 AM the facility provided a copy of R209's care plan. The facility copy now included the goal for wanting to lose weight due to [MEDICAL CONDITION] and [MEDICATION NAME] treatment and weight loss is expected and beneficial. The interventions include the following: monitor resident for greater than 2% weight changes weekly; send weekly reports to dietitian for further evaluation of weight changes greater than 2%; and report the significant changes to the physician, dietitian and resident representative. | 2020-09-01 |