| 37 |
BELLA TERRA OF BILLINGS |
275020 |
1807 24TH ST W |
BILLINGS |
MT |
59102 |
2019-04-18 |
692 |
G |
0 |
1 |
D2B811 |
Based on observation, interview, and record review, the facility failed to provide a resident adequate assistance for eating; failed to assess the effectiveness of the weight loss and nutritional interventions and implement new interventions; and failed to provide a breakfast and lunch tray to a resident. The accumulation of the failures increased the risk of the resident's continued severe weight loss of 15 percent in six months, for 1 (#17) of 30 sampled residents. Findings include: During an observation on 4/16/19 at 9:09 a.m., resident #17 was sleeping in her reclining chair. No breakfast tray had been delivered to the resident. During an observation on 4/16/19 at 10:43 a.m., resident #17 had not appeared to have moved from her position, observed earlier that morning. During an observation on 4/16/19 at 12:20 p.m., resident #17 continued to appear to be in the same position from the morning observations. No lunch tray had been delivered to the resident. The resident responded to her name, smiled, and nodded 'yes' when asked if she was hungry. She was attempting to eat sugar free cookies. During an observation on 4/16/19 at 12:39 p.m., resident #17 was sleeping. An unwrapped Rice Krispee bar was on her bedside table. Review of resident #17's physician order, dated 4/1/19, showed she was on a pureed diet. During an observation on 4/16/19 at 1:43 p.m., staff member F entered resident #17's room and provided toileting care. No food or fluids were offered to the resident. During an observation and interview, on 4/16/19 at 6:23 p.m., resident #17 received a dinner tray consisting of pureed soup and ice cream. Staff member H stated the resident did not eat very much, but liked ice cream. During an interview on 4/17/19 at 8:40 a.m., staff member G stated she did not know why resident #17 did not get the pureed meal, as specified on the therapeutic breakdown sheet. She stated the resident room trays on resident #17's hall were delivered one at a time, by the CNAs, because the facility did not have a food delivery cart. She stated the facility did not serve the room trays until the CNA came to the kitchen to pick them up. During an interview on 4/17/19 at 8:30 a.m., staff member T stated the resident had been refusing meals for the past six months. Staff is offering her snacks and sandwiches. She needs more help now with eating. Staff member T stated the CNAs were responsible for making sure every resident eating in their room received a meal tray. Review of resident #17's Quarterly MDS, with the ARD of 6/20/18, showed a weight of 160 pounds. Review of resident #17's weight record, dated 11/4/18, showed the resident weighed 137 pounds. On 4/2/19, the resident weighed 120.2 pounds. Review of resident #17's Physician Order, dated 2/15/19, showed, Glucerna, one BID. During an observation and interview on 4/18/19 at 9:45 a.m., the nutritional supplement closet did not contain Glucerna. Staff member G stated she did not know any residents were to receive Glucerna. Review of resident #17's Physician Order, dated 3/26/19, showed the resident was too tired to chew her food, and her food texture was downgraded to a mechanical soft texture. No other interventions were implemented for resident #17's 40 pound weight loss. Review of resident #17's Care Plan, dated 11/15/18, showed one new intervention for the mechanical soft texture. All other interventions were dated 4/11/18. Review of resident #17's Notification to the Physician for weight loss, dated 4/10/19, showed a 15 percent weight loss in 90 days, and intakes variable but less than 50 percent. Supplements in use, sometimes accepted. No new interventions were recommended by the facility or physician. Review of resident #17's most current Dietary Evaluation, dated 2/4/19, showed Resident unwilling to accept food supplement or to eat more than 3 meals a day. Staff are providing cues and encouragement for nutrition and hydration. Recommend Glucerna or house equivalent supplementation with meals tid. No supplement was observed with the dinner meal served 4/16/19 at 6:23 p.m. |
2020-09-01 |