cms_HI: 86
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 86 | MALUHIA | 125009 | 1027 HALA DRIVE | HONOLULU | HI | 96817 | 2017-06-02 | 325 | D | 0 | 1 | HXLB11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interviews and medical record reviews (MRR), the facility failed to ensure that the physician participated in the nutritional assessment, and that a more in-depth nutritional assessment was done to identify nutrition related risks for 1 of 24 residents (R#129) on the survey Stage 2 sample resident list. Findings include: On 06/01/2017 at 12:03 PM observed R#129 eating lunch in the activity/dining room (rm) on the facility's second floor unit. The resident was able to self-feed the pureed meal served on a divided plate. The resident drank all of the fluids served in 6 ounce plastic cups and also the 1/2 cup of applesauce. After finishing all of the liquids of milk, apple juice, water and pureed applesauce, R#129 started to eat spoonfuls of pureed beef mac casserole and chicken rice soup. The resident was sampled for nutrition due to having a body mass index (BMI) of 18.2 and with no physician ordered supplement. On 06/01/2017 at 1:01 PM the MRR on R#129, found that the 2/7/17 speech/swallowing therapy evaluation for swallowing recommendations were for pureed solids and honey consistency liquids with feeding by nursing to observe for actual swallow. The residents weight (wt) on 5/24/17 was 87 lbs; 5/10/17 was 89 lbs in the units weight book. On 06/01/2017 at 1:05 PM interviewed Staff#24 as noted that the last nutritional assessment was done on 2/1/17 after an acute hospitalization for [DIAGNOSES REDACTED] ulcer perforation when R#129 was on GT feeding. Staff#24 stated that R#129 pulled out his/her gastrostomy tube (GT) on 2/14/17, and was put on intravenous (IV) fluids and pureed diet. The R#129 also pulled out the IV. On 2/15/17 the MD recommended not to replace GT/JT because the resident would continue to pull out tubes and would replace if he/she had poor intake. Since 2/15/17 R#129 received a pureed diet and doing well. Staff#24 stated that registered dietitian (RD) was included on interdisciplinary (IDT) meetings and provided documentation for the 2/14/17 IDT meeting on R#129, which the RD noted significant wt loss and resident on TF. Queried Staff#24 if RD did nutritional evaluation after R#129 switched to pureed diet and CN provided that 5/2/17 IDT meeting notes documented, see RD notes 5/2/17, but Staff#24 unable to locate RD notes. Staff#24 called RD and RD had documentation in her office. Continued to do MRR and R#129's care plan (CP) #12 dated 5/9/17, I am underweight related to significant weight loss AEB BMI Queried Staff#24 if supplement should be in treatment record. Staff#24 looked at R#129's treatment record and there was no supplement included. Staff#24 went to the unit's refrigerator and Boost Plus 120 ml was on the nourishment tray for R#129. According to Staff#24, the IDT develops each resident's CP and the resident's supplement should have been on the treatment record. On 06/01/2017 at 2:10 PM interviewed Staff#24 who was find out why the RD didn't reassess R#129 for supplement recommendation after the GT was discontinued on 2/15/17 but she could not provide an explanation. Queried Staff#24, on why supplement was started on 5/17 but sig wt loss was noted at the 2/17 IDT meeting, and she could not provide an answer. The resident's nursing assessment on 3/20/17, documented a wt of 85.2 lbs; and on 3/29/17, wt 85.4 lbs. On 06/01/2017 at 2:16 PM interviewed the RD and she related that on 2/17/17 the resident's niece and family were convincing R#129 to eat because the resident was refusing to eat and on that date started the supplement on a trial basis to see if the resident would drink the supplement. The IDT progress notes dated 2/17/17 Nutrition Follow-up, documented, Boost Plus 240 ml PO TID between meals. On the 5/2/17 IDT conference notes documentation; decreased Boost Plus 120 ml TID btw meals d/t improved intakes. Staff#24 and the RD looked through R#129's medical record and could not find an MD order for the supplement. On 06/02/2017 at 11:01 AM, the MRR on R#129, found a physicians telephone order dated 06/01/17 written with, (late entry for 5/2/17); 1) D/C Boost Plus 240 ml P.O. TID between meals 2) Decrease to Boost Plus 120 ml P.O. TID between meals. T.O. Dr. R. Gries, signed by Staff#24. On 06/02/2017 at 11:42 AM observed R#129's food tray with Staff#24 and Staff#88 in the dining/activity rm. There was a regular spoon on the resident's tray and not a built-up spoon as was ordered by the occupational therapist. According to Staff#24, the resident used the built-up spoon only when dining in-room because they didn't want to misplace the built-up spoon. Staff#88 further stated that R#129 didn't like to use the built-up spoon and would sometimes throw it. Staff#88 went to get the built-up spoon from R#129's rm and stated that she would try to make the resident use it. Discussed with Staff#24 that the use of the built-up spoon should be re-evaluated as resident observed to be using small disposable plastic cups to drink pureed food. The facility failed to provide nutritional care and services consistent with a comprehensive assessesment as the MD did not write the order for nutritional supplements, the built-up spoon was not re-evaluated for use when staff knew that the resident did not want to use it. | 2020-09-01 |