cms_AZ: 9
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 9 | THE TERRACES OF PHOENIX | 35003 | 7550 NORTH 16TH STREET | PHOENIX | AZ | 85020 | 2019-10-17 | 658 | E | 0 | 1 | EJUZ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, observations, staff interviews, and policy review, the facility failed to ensure services provided met professional standards of quality by failing to follow physician orders [REDACTED].#19). The deficient practice could result in adverse clinical outcomes. Findings include: Resident #19 was admitted on [DATE] with a [DIAGNOSES REDACTED]. Review of the current care plan revised 9/4/18 revealed the resident had a potential nutritional problem related to decreased cognition as evidenced by variable meal intake around 50% and the need for assistance/coaching. The goal was for the resident to maintain adequate nutritional status. Interventions included providing set-up and assistance with meals in the dining room as needed/accepted and monitoring, documenting, and notifying the physician as needed for refusals to eat and concerns during meals. Review of the percentage of meals eaten revealed the following for (MONTH) and (MONTH) 2019: For July, 36 meals the resident consumed was 50% or less. For August, 39 meals the resident consumed was 50% or less. The quarterly admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident cognitive skills were moderately impaired for daily decision making and the resident required supervision for eating. A quarterly nutrition review dated 8/30/2019 revealed the resident had decreased her consumption of solid food to 26-50% but was not a risk for unintended weight loss. Review of the summary of physician orders [REDACTED]. The percentage of meals eaten for (MONTH) and (MONTH) 2019 revealed the following: For September, 32 meals the resident consumed was 50% or less. For (MONTH) 1-16, 20 meals the resident consumed was 50% or less. Further review of the clinical record revealed no documentation that 1:1 assistance was provided to the resident as ordered or that the care plan included this order. An observation was conducted of the resident on 10/15/19 at 09:38 AM. The resident's breakfast was sitting in front of her on a bedside table. The breakfast was a full size waffle, fries and bacon. The resident was not observed to attempt to eat the food in front of her and no staff were observed in the resident's room. During a lunch observation conducted on 10/15/19 at 12:53 PM, a Certified Nursing Assistant (CNA) was observed to deliver the resident's tray, raise the head of the bed, set up the tray, and leave the room. An observation was conducted of the resident in the north dining room on 10/16/19 at 12:10 PM. She was sitting at a table with three other residents and a CNA was sitting across from the resident assisting two other residents. The resident was observed drinking out of a cup without assistance. The resident was observed unable to grasp the spoon on the table to eat the bowl of food in front of her. The resident was unable to eat until staff assisted her. An attempt was made to interview the resident however; the resident was unable to answer questions. The resident would say one word and make facial expressions. In interview conducted with a CNA (staff #20) on 10/16/19 at 10:39 AM., she stated the resident makes up her own mind about where and when she eats. The CNA stated that when the resident eats her meals in her room sometimes she eats by herself because if staff stays in the room, the resident will not eat. She stated that they will leave the resident alone to eat and will check back on her. The CNA stated that if they notice the resident needs help, they will help her. An interview was conducted with a Licensed Practical Nurse (LPN/staff #61) on 10/16/19 at 12:44 PM. She stated that if the staff is concerned with the resident's meal intake, they can obtain an order for [REDACTED].#61 stated staff will leave the resident alone when she eat her meals in her room but will pop in to check on her every 15-20 minutes. She stated they follow the care plan for the resident's nutritional needs. She also stated the resident is weighed monthly now because she is not a high risk for weight loss. During an interview conducted with the Director of Nursing (DON/staff #4) on 10/16/19 at 12:54 PM., she stated that if a resident is not eating more than 50% of their meals, she expects the CNA to report it to the nurse so the Interdisciplinary Team (IDT) team can address it in the morning meeting. She stated the staff should also address the lack of intake with the resident and offer other options. The DON stated that when a resident is a high risk for weight loss they are weighed weekly. She stated this resident is not at high risk and is weighed monthly. She stated she was not aware there was an order for [REDACTED]. In an interview conducted with the Dietary Manager (staff #125) on 10/16/19 at 01:18 PM., she stated this resident is not at risk for weight loss based on the resident's intake per meal, Body Mass Index (BMI), lab work, and the quarterly/annual reviews. She stated she was not aware the resident had an order for [REDACTED].>The facility's policy titled Clinical Nutrition Services: Nutrition Assessment and Monitoring revised 8/2019 revealed the individualize plan of care will be written and reviewed regularly when changes are noted. The plan of care will be shared with and agreed upon by the resident and/or representative. The nutrition assessment will include data from staff members including meal intake and appetite. Interval assessments will be completed for nutritional concerns such as poor intake of food/fluid and refusal to eat. | 2020-09-01 |