| 44 |
THE MEADOWS ON UNIVERSITY |
355024 |
1315 S UNIVERSITY DR |
FARGO |
ND |
58103 |
2018-12-06 |
692 |
D |
1 |
0 |
PNS511 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on information provided by the complainants, observation, record review, review of the professional references, review of facility's policy, and resident/staff interviews, the facility failed to address the needs and monitor weight for 1 of 1 sampled resident (Resident #10) already experiencing impaired nutrition. Failure to develop and implement interventions in a timely manner may result in Resident #10 experiencing impaired wound healing, a decline in function, and/or unplanned weight loss. Findings include: Information provided by the complainants indicated facility staff failed to provide snacks and/or supplements to residents at high risk for weight loss. The complainant also reported families/representatives were directed to purchase snacks for residents. Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice, 10th ed., Pearson Education, Inc., New Jersey, page 862, states, . Several factor increase the risk for the development of pressure ulcers: . inadequate nutrition . Nursing interventions to prevent the formation of pressure ulcers include . ensuring adequate nutrition and hydration . Review of the facility's policy titled Weight Assessment and Intervention occurred on 12/06/18. This policy, dated (YEAR), stated, . The nursing staff will measure resident weights on admission, and monitor until no weight concerns noted. The . multidisciplinary team may identify conditions . that may be . increasing the risk of weight loss. For example . Increased need for calories and/or protein . (Careplanned) Interventions for undesirable weight loss shall be based on careful consideration of . Resident choice and preferences . The use of supplementation . Review of Resident #10's medical record occurred on all days of survey. The record identified [DIAGNOSES REDACTED]. The current physician's orders [REDACTED]. * 11/19/18, [MEDICATION NAME] (an appetite stimulant) 40 mg/ml (milligrams/milliliters) suspension take 10 ml (400 mg) by mouth once daily. * Undated, Nepro supplement twice a day. The current Medication Administration Record [REDACTED]. A handwritten note stated, See P[NAME] (Plan of Care). The record lacked evidence Resident #10 received Nepro twice daily per order, that the order for Nepro had been discontinued after 11/20/18, and/or that another supplement had been ordered. A Braden Scale, dated 11/19/18 (the evening of Resident #10's admission to the facility), identified, . Adequate (Nutrition): Eats over half of most meals. Eats a total of 4 servings of protein . Occasionally will refuse a meal, but will take a supplement when offered . It is unclear how staff determined she ate greater than 50% of most meals, ate 4 servings of protein daily, and/or occasionally refused meals. A Nutritional Assessment, dated 11/20/18, identified, . Height . 60 (inches or 5 feet)Admitting Weight in LBs (pounds) . 86 . BMI (Body Mass Index) . 16.7 (Underweight = The facility provided a copy of Resident #10's current snack schedule. The schedule identified the following: * Dislikes . Wheat Bread . Pancakes * 11/20/18, MWF (Monday, Wednesday, Friday) EV (Evenings): 1 Bag Cheez-its * 11/26/18, Su, Tu, Th, Sa (Sunday, Tuesday, Thursday, Saturday) AM: 4 oz (ounces) 2% Milk (The schedule failed to reflect Resident #10's dislike of milk.) . EV: 4 oz Vanilla Ice Cream . MWF EV: 4 oz Grape Juice . PM: 4 oz Vanilla Ice Cream * 11/30/18, Su, Tu, Th, Sa PM: 1/2 cup Cheese Cubes . EV: 3 Packs Saltine Crackers * 12/04/18, MWF AM: Margarine & Mayo w (with)/Sandwich . 1/2 [NAME] Meat and Cheese Sandwich * 12/05/18, All Days . BR (Breakfast): [NAME] Toast, PB (peanut butter), Jelly . PM: 8 oz (ounces) Boost Vanilla The current care plan identified, . Focus: Potential for or presence of altered nutrition needs related to . selective food preferences, unwillingness to accept nutritional supplements, BMI (body mass index) The progress notes identified the following: * 11/19/18, . Dinner was served . Consumed about 50%. * 11/20/18, . appetite is fair . Snacks . encouraged. * 11/21/18, New orders per (Physician) for Boost Liquid Supplement four times daily. The current physician's orders [REDACTED].>* 11/28/18, Nutrition Admission Assessment . (Staff re-entered data from the nutritional assessment completed on 11/20/18, nine days prior to this entry. The progress note failed to accurately reflect Resident #10's weight, current physician's orders [REDACTED].) * 12/02/18, . appetite is fair. resident is thin . * 12/04/18, . wt 86# (pounds), eats 50-100% of meals on an enhanced diet, on an appetite stimulant. Receiving scheduled snacks. Dislikes most nutritional supplements. In the (care) conference more attention to be paid to . diet. Patient appetite fair most of the time. Encouraged . snacks. Observation showed the following: * 12/05/18 at 6:05 p.m., Resident #10 received a supper tray containing a pimento (pepper) and cheese with mayonnaise sandwich, green beans, pudding, coffee, milk (despite her dislike for milk), and grape juice. Resident #10 ate the crust off her sandwich. When asked about her meal, she stated, What is this? I don't like it (sandwich). I'd rather have toast. That's cold. I don't want them (beans). I don't eat that (pudding). * 12/06/18 at 8:10 a.m., Resident #10 reported an administrative staff member (#2) entered her room the night before and stated, Oh, you don't like Mexican (food), and returned with a bowl of chicken noodle soup. Resident #10 then made the comment, My stomach hurts. When asked what was causing her discomfort, she stated, I'm just hungry. She asked the surveyor for assistance opening a snack-pack of mandarin oranges, which she reported her two friends brought her. * 12/06/18 at 9:22 a.m., Resident #10 received a breakfast tray containing an egg, English muffin, oatmeal, prunes, coffee, milk (despite her dislike for milk), and orange juice. Resident #10 stated, I don't like these (English muffins), and asked the Certified Nursing Assistant (CNA) (#3) to bring her a piece of toast. She ate the toast and half an egg, and drank half a glass of juice. * No observations were made of staff members offering Resident #10 snacks on either day of survey. During an interview on 12/06/18 at 10:55 a.m., a CNA (#4) assisted Resident #10 prior to [MEDICAL CONDITION]-treatment appointment. When asked if she planned on sending a snack with Resident #10, the CNA (#3) stated, (Resident #10) ate breakfast, so I don't think she needs anything. During an interview on the afternoon of 12/06/18, an unidentified dietary staff member reported Resident #10's guardian recently talked her into taking the supplement Boost. The staff member also reported there is no documentation reflecting Resident #10's actual intake, as staff are only required to document whether she accepts or refuses the snacks offered. After identifying Resident #10 as malnourished and at risk for weight loss, the facility failed to: * Provide supplements as ordered, * Accurately document Resident #10's baseline weight, * Continue to monitor Resident #10's weight until they were able to determine no weight concerns existed, * Care plan Resident #10's choices/preferences or supplementation as specified in the facility's policy, * Supply Resident #10 with snacks prior to transport to appointments scheduled over the noon hour, and/or * Monitor/document Resident #10's snack intake in an effort to determine their caloric benefits. |
2020-09-01 |