| 2944 |
RIDGECREST REHABILITATION CENTER |
285239 |
3110 SCOTT CIRCLE |
OMAHA |
NE |
68112 |
2018-01-23 |
692 |
H |
1 |
0 |
L1D311 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > LICENSURE REFERENCE NUMBER 175 NAC 12-006.09D8b Based on observation, record review and interview; the facility staff failed to identify significant weight loss and failed to implement interventions to prevent weight loss for 4 of 4 sampled residents (Resident 20, 23, 24, and 25). The facility staff identified a census of 60. Findings are: [NAME] Record review of a Face Sheet dated 8-18-2017 revealed Resident 20 was admitted to the facility on [DATE] and re-admitted on [DATE] with the [DIAGNOSES REDACTED]. Record review of Resident 20's Minimum Data Set (MDS, a federally mandated assessment tool used for care planning) signed as completed on 12-26-17 revealed the facility staff assessed the following about the resident: -Totally depended for bed mobility, transfers, dressing, eating, dressing, toilet use and personal hygiene. Record review of a weight record sheet (WRS) provided by the facility revealed Resident 20's weight on 9-13-17 was 268 pounds. Further review of the WRS revealed Resident 20's weight on 11-8-17 was 233.4 pounds, a loss of 34.6 pound weight loss or 11.39% indicating a significant weight loss. Record review of a Progress Note (PN) dated 12-9-17 (a 31 day span from the significant weight loss identified on 11-8-17) revealed the facility Registered Dietician (RD) identified Resident 20 had lost weight, According to the RD PN dated 12-9-17, Resident 20 had not been hungry and Resident 20's weight loss was greater than 1 pound a week .which indicates a caloric deficit resulting in loss. Further review of Resident 20's RD, PN dated 12-9-17 revealed there was no evaluation of Resident 20's nutritional requirements, no evaluation of Resident 20's medical condition related to the weight loss or what interventions were to be implemented to stabilize Resident 20's weight. Record review of Resident 20's Comprehensive Care Plan (CCP) dated 5-9-16 revealed Resident 20 had impaired nutritional status. According to Resident 20's CCP dated 5-9-17 with an updated intervention dated 7-7-2016 revealed Resident 20 was to have large portions of foods at meal times. Further review of Resident 20's CCP date 5-16-17 revealed there was not an indication any weight loss was planned for Resident 20. Record review of an undated dietary food tray slip revealed Resident 20 was to receive large portions. Observation on 1-9-18 at 8:07 AM revealed Resident 20 was served for breakfast, 2 pancakes, 2 link sausage, small bowel of cut up fruit and several drinks. On 1-9-2018 at 8:10 AM an interview was conducted with the Dietary Services Manager (DSM). During the interview the DSM confirmed Resident 20 was to receive large portions at meals and further confirmed Resident 20 was served a regular sized portion for breakfast on 1-9-18 at 8:07 AM. On 1-9-2018 at 4:45 PM an interview was conducted with the Director of Nursing (DON). During the interview the DON confirmed Resident 20 had a significant weight loss and did not have interventions to stabilize Resident 20's weight. B. Record review of Resident 25's CCP dated 11-9-2013 revealed Resident 25 had the potential for a nutritional deficit. The goal identified for Resident 25 was to maintain weight. Interventions identified on the CCP included monitor weights, a lip plate and covers for drinks. Further review of Resident 25's CCP revealed on 7-24-16 a new intervention was identified to give Resident 25 finger foods. Record review of Resident 25's Dietary Card (DC) revealed Resident 25 was on a regular diet that was mechanically altered. There was no indication on Resident 25's DC that Resident 25 was to be offered or receive finger foods. Record review of Resident 25's WRS dated 10-25-17 revealed Resident 25's weight was 170 pounds. Review of Resident 20's WRS dated 12-27-17 revealed a weight of 158 pounds, a loss of 12 pounds or 7.05 percent. Record review of the WRS dated 1-8-18 revealed Resident 25's weight was 149.8, a loss of 20.2 pounds or 11.88% compared to the weight on 10-25-2017. Review of Resident 25's record revealed there was no evidence Resident 25's weight loss on 12-27-17 and again on 1-8-18 had been evaluated or any additional interventions were implemented to stabilize Resident 25's weight. Observation on 1-9-18 at 12:40 PM revealed Resident 25 was served chicken cut up, long noodles, vegetables served on a lip plate, a slice of chocolate cake and several types of drinks. The lip part of the plate had been positioned away from Resident 25. Resident 25 was not able to scoop food up against the raised part of the plate to get food resulting in food being dropped onto Resident 25 or the floor. Further observations revealed Resident 25 was in a wheelchair and positioned as if Resident 25 was sliding out of the wheelchair resulting in Resident 25 struggling to reach the lunch meal, in addition, Resident 25 did not have finger foods provided. On 1-10-18 at 9:00 AM an interview was conducted with the facility Nurse Consultant (NC). During the interview the facility NC confirmed Resident 25 had weight loss with resulting significant weight loss and did not have an evaluation completed or additional interventions implemented to stabilize Resident 25's weight. The NC further confirmed Resident 25 had not received finger foods at lunch on 1-9-18 at 12:40 PM. On 1-10-18 at 11:40 AM an interview was conducted with the facility RD. During the interview, the facility RD reported while the weight identified on 12-27-2017 .is of significant concern as (Resident 25) was trending down wards. The RD reported during the interview Resident 25 should have had an assessment completed at that time and did not. C. Record review of Resident 23's CCP dated 7-22-17 revealed Resident 23 was at risk for nutritional problems. The goal for Resident 23 was to maintain weight. Interventions identified on the CCP included large supper, magic cup and to offer snacks. Record review of Resident 23's PN dated 12-10-17 revealed the facility RD had identified interventions which included magic cup, superceral, fortified potatoes and 2 eggs at breakfast. Record review of an undated DC for Resident 25 revealed Resident 25's staff were to give Resident 23 a large meal in the evening, superceral and 2 eggs for breakfast. In addition, the DC identified Resident 23 was allergic to chocolate and tomatoes. Observation on 1-8-2018 at 6:25 PM revealed Resident 23 was served a BBQ sandwich, baked beans, cooked cabbage, desert and drinks. On 1-8-18 at 6:30 PM the NC replaced Resident 23's meal with 1 ground hamburger, soup and a new desert. Observation on 1-9-18 at 8:20 AM revealed Resident 23 was served cold cereal (cheerio type), 2 pancakes, 2 sausage with gravy and several drinks. On 1-9-18 at 8:35 AM an interview was conducted with Nursing Assistant (NA) [NAME] During the interview NA A confirmed Resident 23 did not have eggs or supercereal. On 1-10-18 at 2:40 PM an interview was conducted with the DSM. During the interview, the DSM reported a large portion would be 1 and 1/2 portions of a regular sized portion. The DSM confirmed 1 hamburger was not a large portion. D Record review of Resident 24's CCP dated 4-28-17 revealed Resident 24 was at nutritional risk. The goal identified for Resident 24 was to maintain weight. Interventions included double portions at all meals. Record review of Resident 24's DC revealed Resident 24 was to have double portions at meals. Observation on 1-8-18 at 6:27 PM revealed Resident 24 was served 1 BBQ sandwich, baked beans, cook cabbage, desert and fluids. Observation on 1-9-18 at 8:20 AM revealed Resident 24 was served 2 pancakes, 2 sausage, cereal and fluids. On 1-9-18 at 8:36 AM an interview was conducted with NA [NAME] During the interview NA A confirmed Resident 24 did not receive double portions for breakfast. Record review of the facility Policy and Procedure for Weight Assessment and intervention dated 4-2012 reveled the following information: -Analysis: -Assessment information shall be analyzed by the multidisciplinary team and conclusions shall be made regarding: -a. Approximate calorie, protein, and other nutrient needs compared with the resident's current intake. -c. The relationship between current medical condition or clinical situation and recent fluctuations in weight. |
2020-09-01 |