| 6 |
HERITAGE PARK HEALTHCARE AND REHABILITATION |
465003 |
2700 WEST 5600 SOUTH |
ROY |
UT |
84067 |
2018-01-17 |
692 |
D |
0 |
1 |
1JS611 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review it was determined that the facility did not maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range, unless the resident's clinical condition demonstrated that this was not possible. Specifically, there were 2 resident's that lost weight and nutritional interventions developed were not implemented. Resident identifiers: 11 and 66. Findings include: 1. Resident 11 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/9/18 at 12:45 PM, resident 11 was observed in the Secured Unit (SNU) dining room. Resident 11 was observed to ask the Restorative Nurses Aide (RNA) to take her back to her room. Resident 11 was observed to eat 1 bite of food from her plate. RNA confirmed resident 11 ate 1 bite of food. On 1/10/18 at 8:02 AM, resident 11 was observed in the SNU dining room. Resident 11 was observed to drink coffee with milk. Resident 11 was observed to not be served nutritional supplement drink. Resident 11 did not eat more than 25 percent of her meal. On 1/17/18 at 7:57 AM, an observation was made of resident 11 in the SNU dining room. Resident 11 was observed to pour milk into her coffee. Resident 11 was not observed to be provided a nutritional supplement drink. On 1/17/18 at 8:00 AM, an interview was conducted with Certified Nursing Assistant (CNA) 6. CNA 6 stated that nutritional supplement drinks were served with resident's meal and not when coffee was served. Resident 11's medical record was reviewed on 1/11/18. Resident 11's weights documented in the electronic medical record were: (Note: All weights were in pounds.) a. 7/5/17 97.25 b. 8/2/17 95.25 c. 9/5/17 90.25 d. 10/5/17 90.75 e. 11/8/17 90.5 f. 12/8/17 90.5 e. 12/29/17 89.0 g. 1/5/18 89.5 h. 1/12/18 86.0 Resident 11's nutrition progress notes revealed the following: a. 10/20/17 at 4:15 PM, Registered Dietitian Note: Resident back to 90.75#, same as 10/5 wt (weight). Interventions are in place; intake remains low. Will check with nursing intake of coffee with health shake. b. 12/21/17 at 11:26, Registered Dietitian Note: wt 12/21 88.8 loss 2.6% x 1 wk (week), 11/24 91 loss 2.4% x 1 month. Non significant wt loss x 1 month. Wt loss undesired d/t BMI (body mass index) 14.3 underweight.Diet: FORTIFIED PUREED texture, THIN LIQUIDS consistency, EXTRA SAUCES TO MEATS & MASHED POTATOES; to 4 oz health shake mixed with 4 oz milk heated in mug TID (three times a day) with meals. c. 1/10/18 at 11:00 AM, Registered Dietitian Note: resident requests coffee Q (every) meal consumes health shake best if mixed with coffee vs (verses) milk clarify order. Coffee mixed with 1/2&1/2 TID snack remains appropriate. d. 1/11/18 at 11:27 AM, Registered Dietitian Note Note. : wt 1/10 86.2 1/5 89.5 12/8 90.5 loss 3.7% x 1 wt, 4.8% x 1 month non significant wt loss. Wt loss undesired BMI 14.4 underweight. Resident with difficulty swallowing observation snack coughing/choking on liquids. Discussion with ST (Speech Therapist) resident refusing GI consult to r/o (rule out) restriction per ST recommendations. Multiple interventions in place to meet needs. Diet: FORTIFIED PUREED texture, THIN LIQUIDS consistency, EXTRA SAUCES TO MEATS & MASHED POTATOES; 4 oz heated health shake mixed with coffee in mug TID (three times a day) with meals. Snacks TID snack coffee mixed with 1/2&1/2.Resident has been accepting coffee with health shake d/t (due to) wt loss, increased calorie of health shake change snacks to coffee mixed with health shake. change med pass to TID. Resident declines table change to restorative will allow staff to feed at times. Weekly weights in place. RD (Registered Dietitian) to follow PRN (as needed). On 1/17/18 at 9:00 AM, an interview was conducted with the facility RD. The RD stated that resident 11 had weight loss. The RD stated that resident 11 had gastrointestinal issues but the family and resident 11 refused to consult with a specialist. The RD stated that resident 11 should have a nutritional supplement in her coffee three times a day. The RD stated she did not know why resident 11 was not provided the nutritional supplement. 2. Resident 66 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/10/18 at 8:32 AM, an observation was made of a meal that had not been eaten in the dining room. There was a meal ticket with the tray that revealed it was resident 66's breakfast meal. The breakfast meal had not been touched. On 1/10/18 at 9:43 AM, an interview was conducted with Registered Nurse (RN) 1. RN 1 stated that resident 66 was at an appointment. RN stated that he was not sure if resident 66 ate but that he thought she had a yogurt prior to leaving for the appointment. A review of resident 66's weights were as following in the electronic medical record: (Note: All weights were in pounds.) a. 1/12/18 140.0 b. 1/5/18 140.4 c. 12/8/17 149.0 d. 11/8/17 156.0 e. 10/2/17 162.75 f. 9/14/17 159.75 g. 8/2/17 164.25 h. 7/5/17 163.75 Resident 66's nutritional care plan dated 9/6/17 revealed a focus of (Resident 66) has nutritional problems or potential nutritional problems r/t (related to) edentulous requires mechanically alter diet, likes to drink coffee, history skipping meals due to sleeping during the day. Nonsignificant weight loss x 3 months (and) 6 months, HTN, [MEDICAL CONDITION]. Resident desires wt loss to 135 (pounds). 1/5/18 significant wt loss. A few of the goals revealed, Will maintain adequate nutritional status as evidenced by no significant wt change no s/sx (signs or symptoms) of malnutrition through review date and resident to achieve wt loss at non significant rate to 135 (pounds). One intervention developed was, Provide, serve diet as ordered, Monitor intake and record q (every) meal. (Note: Resident 66 was not observed to eat her breakfast meal on 1/10/18 and resident had documented weight loss.) On 1/17/18 at 9:50 AM, an interview was conducted with the Dietary Manager (DM) and Cook 1. DM stated that if a resident had an appointment during a meal the nurse will notify dietary to provide a meal early or provide a sack meal. Cook 1 stated that she had not provided an early meal or sack meal for resident 11. |
2020-09-01 |