| 58 |
MINOT HEALTH AND REHAB, LLC |
355031 |
600 S MAIN ST |
MINOT |
ND |
58701 |
2019-06-11 |
692 |
D |
1 |
0 |
HFFF11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > HYDRATION 1. Based on information provided by the complainants, observation, review of facility policy, record review, and staff interviews, the facility failed to offer fluids 3 of 16 sampled residents (Resident #6, #15 and #16) who required staff assistance for fluid intake and were at risk for dehydration. Failure to provide assistance with fluid intake may result in dehydration, constipation, and urinary tract infections (UTIs). Findings include: Information provided by the complainants indicated nursing staff failed to provide dependent residents assistance with fluid intake. Review of facility policy titled, Hydration Policy occured on 06/11/19. This policy, dated 01/2017, stated, . each resident receives adequate fluids to maintain proper hydration . - Review of Resident #6's medical record occurred on all days of the survey. [DIAGNOSES REDACTED]. The current care plan stated, . Encourage and assist as needed to consume foods and/or supplements and fluids offered . Observation on 06/04/19 at 11:15 a.m., showed a CNA (#13) provided cares for Resident #6 and exited the room. The CNA failed to offer the resident fluids. - Review of Resident #15's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The current care plan stated, . Encourage and assist as needed to consume foods and/or supplements and fluids offered . Observation on 06/05/19 at 1:55 p.m. showed a certified nursing assistant (CNA) (#6) provided cares for Resident #15 and exited the room. The CNA failed to offer the resident fluids. - Review of Resident #16's medical record occurred on all days of survey. [DIAGNOSES REDACTED]. The care plan stated, . Encourage as needed to consume foods and/or supplements and fluids offered . Observation on 06/04/19 at 3:42 p.m. showed two CNA (#7 and #8) provided cares for Resident #16 and exited the room. The CNAs failed to offer the resident fluids. During an interview on 06/06/19 at 10:00 a.m., an administrative nurse (#5) stated he/she expected facility staff to provide fluids during cares. NUTRITION 2. Based on information provided by the complainants, record review, and staff interview, the facility failed to address the nutritional needs for 1 of 1 resident discharged from the facility (Resident #17) who experienced significant weight loss. Failure to identify Resident #17's food preferences and obtain orders for/implement other interventions (i.e.: fotrified foods/supplements) in a timely manner contributed to Resident #17 experiencing significant unplanned weight loss. Findings include: Information provided by the complainants indicated nursing staff failed to put interventions in place to prevent residents from experiencing significant weight loss. Upon request, the facility failed to provide a copy of their policy addressing weight loss. During an interview on 06/04/19 at 3:30 p.m., when asked how the facility addresses residents experiencing weight loss, a managerial dietary staff member (#12) reported monitoring residents for gradual/significant weight loss, and stated, First, I would give the resident fortified foods, and then supplements. I try to do things like cookies, chocolate milk, whole milk, cheese and crackers, cereal, magic cup, sherbet, and peanut butter. If they need help, I ask them to be moved to an assisted table. Review of Resident #17's medical record occurred on all days of survey, and identified [DIAGNOSES REDACTED]. The weight record identified: * 12/03/18, 210 pounds * 01/08/19, 208 pounds (2 pound weight loss) * 02/12/19, 200 pounds (10 pound weight loss) * 04/04/19, 190 pounds (20 pound weight loss) * 05/05/19, 173 pounds (37 pound weight loss) The physician's orders [REDACTED]. * 03/05/19, Consistent Carbohydrate (CCD) diet Ground Meat texture, Regular/Thin consistency, Low Sodium * 03/06/19, [MEDICATION NAME] Tablet 40 mg. * 03/22/19, Fluid restriction as directed by cardiologist . Not > (greater than) 1750 ml in 24 hours. * 04/11/19, Speech evaluation - weight loss. The progress notes, dated 10/02/18-05/05/19, identified the following: * 01/08/19, Quarterly Assessment - (Resident #17) is on a carbohydrate controlled diet with ground meats. Her intakes vary averaging * 01/18/19, Care Plan Progress Note . Dietary was not present. (Resident #17) weighs 208 pounds and usually eats 0-25% of meals. * 03/08/19, . Eats less than 50% of meals Weight Stable . * 03/11/19, . Eats 50% to 75% of meals Weight Stable . * 03/21/19, Care Plan Progress Note . Dietary was not present. (Resident #17) weighs 191 pounds (down 17 pounds since 01/18/19) and usually eats 51-25% of meals. * 03/22/19, . Eats 75%-100% of meals Weight Stable . It is unclear how staff determined Resident #17's weight was stable, when the record showed a 17 pound weight loss the day before. * 03/26/19, . Eats 50% to 75% of meals Weight Stable . * 03/29/19, . (Resident #17) is on a carbohydrate controlled diet/1.5 gm (gram) sodium with ground meats and 1750 ml fluid restriction. Her intakes vary averaging * 03/31/19, . -7.5% change . Wt triggers for significant change. Has been stable for past 2 weeks. Continues on low sodium carbohydrate controlled diet with ground meat and 1750 ml fluid restriction. She is eating * 04/01/19, . Eats 50% to 75% of meals Weight Stable . * 04/23/19, . -10.0% change . (Resident #17) continues to have a wt loss. She averages less than 50% of meals. She takes fluids well. She is on a fluid restricted diet carbohydrate controlled with ground meats. Some of loss maybe r/t (related to) fluid losses. Offer alternates when not eating her meals. She is taking her snacks well. Has [MEDICAL CONDITION] at this time. Continue to monitor. * 05/05/19, . Eats 50% to 75% of meals Weight Stable . The care plan identified, . Encourage and assist as needed to consume foods and/or supplements and fluids offered, Honor food preferences, Provide diet as ordered carbohydrate controlled low sodium ground meat, Review weights and notify MD and responsible party of significant weight loss. The facility failed to individualize Resident #17's care plan identifying specific preferred foods/supplements. During an interview on 06/05/19 at 3:00 p.m., a managerial nurse (#5) confirmed the care plan failed to reflect Resident #17's food preferences and/or the fortified foods, supplements, and snacks recommended for her. After identifying Resident #17 as at risk for significant weight loss, the facility failed to: * notify the physician of Resident #17's significant weight loss, * identify, care plan, and provide preferred foods, fortified foods, supplements, and/or snacks, and * monitor/document Resident #17's intake in an effort to identify which interventions were beneficial and her remaining caloric needs. Refer to F677. |
2020-09-01 |