cms_GU: 31
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 31 | GUAM MEMORIAL HOSPITAL AUTHORITY | 655000 | 499 NORTH SABANA DRIVE | BARRIGADA | GU | 96913 | 2016-09-29 | 322 | D | 0 | 1 | H7FJ11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility did not ensure that a resident who was fed by a gastrostomy tube received the appropriate treatment and services to restore normal eating skills for one of 10 sampled residents (Resident 5). Finding includes: Resident 5 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of the latest MDS assessment dated [DATE] revealed the resident had a BIMS of 15 indicating that he was cognitively intact and totally dependent and required one person physical assist with bed mobility, dressing, eating, toilet use, personal hygiene, and bathing. On 9/26/16 at 10:50 a.m., during the initial tour, the resident was observed in bed inside a dark resident room with all window curtains drawn. The resident was awake and communicated by text messages using his personal cell phone. The resident was observed with right upper extremity contracture and able to move his left hand. On 9/27/16 at 8:30 a.m. during breakfast meal observation, Resident 5 was observed in his room eating pureed diet with foamy liquid at the side of his mouth. A nurse at the hallway was notified and assisted the resident in suctioning his mouth. Review of the latest quarterly assessment dated [DATE] revealed the resident had a BIMS of 15 indicating that he was cognitively intact and he was totally dependent with one person physical assist with eating. The active [DIAGNOSES REDACTED]. He was noted as having no signs and symptoms of swallowing disorder and had no weight loss in the last 6 months. He was described as having an abdominal feeding tube (PEG) and was receiving mechanically altered diet (pureed food). The resident received 51% or more proportion of total calories and an average fluid intake of 500 cc/day or more through tube feeding. Review of the dietetic technician's latest documentation dated 9/12/16 revealed the following: Recommended enteral feeding: Glucerna at 4 cans per day and pureed diet with honey-like liquids for pleasure feeding. Patient receiving an average of 4 cans per day from 9/2/16 per MAR (medication administration record). Total calories consumed 1000 kcal/day from [MEDICATION NAME] d/t (due to) NIS (not in stock) Glucerna and additional kcal from pleasure feeding meals. Total protein consumed 44 gm/day [MEDICATION NAME] d/t NIS Glucerna and additional protein from pleasure feeding meals. Additional documentation revealed that the estimated nutrient needs according to the registered dietitian (RD) was: 1525 - 1830 kcal (25-30 kcal/kg actual body wt. 61 kg); 49-61 gram protein (1.2 g pro/kg); and that based on the CNA flowsheet, the patient consumed 25% of pleasure eating. Further review of the resident's electronic record revealed that the resident was last seen by the RD on 11/29/15. The RD notes stated: Current weight 58.2 kgs. Patient remains to be nutritionally stable. On [MEDICATION NAME] 4 cartons per day plus puree diet per orem. Weight is considered stable. No issues with BM (bowel movement) and no sick day for the month. To continue with same diet regimen. The date of the last RD1 evaluation was confirmed by RD2 after making a telephone call with RD1 on 9/29/16. Review of the speech therapist's (ST) evaluations in the hospital were last conducted on 2013 and 2014. As of 11/12/13 the ST notes indicated that the resident did well, tolerated oral trials of puree and oral trials of regular thin liquids with no overt s/s (signs and symptoms) of laryngeal penetration, and that swallowing appeared to be intact. The speech therapy weekly note dated 1/02/14 indicated the patient continued to improve. The last hospital speech therapy note dated 1/17/14 revealed documentation on working with the resident's speech and how the patient continues to prefer pad and pen to communicate. Review of the resident's care plan dated 7/12/15 revealed a problem: Patient has been on TF (tube feeding) for several months and still not weaned from it. Outcome: reduce the amount of tube feeding and increase oral feeding. Intervention: will increase puree items in tray and monitor oral intake. On 5/16/16, the speech-language initial note revealed that the rehab order for swallow re-evaluation was acknowledged. However, the resident refused to attempt the evaluation to advance his diet. Gestured by holding throat that the current diet is ok and didn't want to try nectar like thickened liquids as well as the mechanically chopped solids. Pt. (patient) currently has Peg. Will defer BSA when Pt complies to participate in test at next work session. On 9/28/16 at 10:00 a.m. interview with LN1 revealed that the resident received a pureed diet for oral pleasure in addition to tube feedings four times a day. She also indicated the resident was currently capable of eating independently once the tray was set up next to him and had not exhibited any signs and symptoms of aspiration. LN1 stated that the resident continued to have the tube feeding because the resident did not get enough calories from the pureed diet served for pleasure meals. However, it was confirmed that there were no attempts to reduce the tube feeding solution given and increase the amount of puree items in his meal tray to increase his oral intake as indicated in the resident's care plan. | 2020-09-01 |