cms_UT: 2
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2 | HERITAGE PARK HEALTHCARE AND REHABILITATION | 465003 | 2700 WEST 5600 SOUTH | ROY | UT | 84067 | 2018-01-17 | 676 | E | 0 | 1 | 1JS611 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, it was determined the facility did not give the appropriate services to maintain or improve the resident's activities of daily living for 5 of 30 sample residents. Specifically, residents did not receive assistance with eating. Resident identifiers: 7, 11, 36, 54 and 56. Findings include: 1. Resident 36 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/9/18, the noon meal service was observed on the Special Needs Unit (SNU). Resident 36 was served his meal at 12:07 PM. Resident 36 was not cued to eat until 12:17 PM at which time resident 36 consumed his first bite of food. Resident 36's medical record was reviewed on 1/16/18. On 11/14/17, the facility staff completed an annual Minimum Data Set (MDS) Assessment. The facility staff assessed resident 36 as needing extensive assistance with a one person physical assist when eating meals. The facility staff developed a nutritional care plan with documented goals of, no wt (weight) loss and Will maintain adequate nutritional status as evidenced by maintaining weight with no s/sx (signs or symptoms) of malnutrition through review date. One of the interventions developed to achieve the goals included Provide assistance or cueing with meals as needed. 2. Resident 56 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/10/18, the breakfast meal service was observed on the SNU. Resident 56 was served her meal at 8:03 AM. Resident 56 was not cued or assisted to eat until 8:21 AM at which time resident 56 consumed his first bite of food. Resident 56's medical record was reviewed on 1/11/18. On 11/30/17, the facility staff completed a quarterly MDS Assessment. The facility staff assessed resident 56 as needing extensive assistance with a one person physical assist when eating meals. The facility staff developed a nutritional care plan with documented goals of, Will have no significant weight change thru (sic) next review and Will tolerate diet texture w/o (without) signs of aspiration through next review. One of the interventions developed to achieve the goals included, Provide set-up, supervision, cues and assistance as needed with meals and snacks. 3. Resident 11 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/9/18 at 11:58 AM, an observation was made of resident 11 in the dining room. Resident 11 was observed to be assisted with eating at 12:35 PM by the Restorative Nurses Aide (RNA). (Note: Resident 11 waited 37 minutes for assistance with eating.) On 1/10/18 at 8:02 AM, an observation was made of resident 11 in the dining room. Resident 11 was observed be served her breakfast meal at 8:02 AM. Resident 11 was assisted by the facility Registered Dietitian (RD) at 8:28 AM. (Note: Resident 11 waited 26 minutes for assistance with eating.) Resident 11's medical record was reviewed on 1/11/18. A quarterly MDS dated [DATE] revealed that resident 11 required supervision with oversight, encouragement, or cueing set up help only. A nutrition care plan dated 8/9/17 revealed a Focus of Has nutritional problems or potential nutritional problem r/t (related to) low BMI (Body Mass Index). Requires mech (mechanical) altered diet. Increased needs r/t repletion. 8/9/17 significant undesired wt (weight) loss. A goal developed was, Will maintain adequate nutritional status as evidenced by maintaining weight without further wt loss no s/sx of malnutrition through review date. An intervention developed was, Provide assistance or cueing with meals as needed. On 1/17/18 at 7:57 AM, an interview was conducted with Certified Nurse Assistant (CNA) 5. CNA 5 stated that resident 11 required assistance with eating. CNA 5 stated that resident 11 refuses at times but resident will respond to verbal cueing for eating. On 1/17/18 at 9:00 AM, an interview was conducted with the RD. The RD stated that resident 11 needed to be assisted with eating. The RD stated that resident 11 should not wait over 20 minutes for assistance with eating. 4. Resident 54 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. On 1/9/18 at 11:58 AM, an observation was made of resident 54 in the dining room. Resident 54 was assisted with her lunch meal at 12:19 PM by Registered Nurse (RN) 3. RN 3 was observed to verbally cue resident 54 with eating. (Note: Resident 54 waited 21 minutes for assistance with eating.) On 1/10/18 at 8:06 AM, an observation was made of resident 54 in the dining room. Resident 54 was observed to take a bite out of a dry piece of toast. Resident 54 was observed to put her thumb into her cereal and licked it several times. Resident 54 was observed to have her breakfast plate placed about 6 inches in front of her. At 8:20 AM, an observation was made of a staff member placing a spoon in resident 54's cereal. Resident 54 was not observed to be assisted or cued for 14 minutes after her meal was delivered. An admission MDS dated [DATE] revealed that resident 54 required 1 person supervision, oversight, encouragement or cueing with eating. A care plan dated 11/22/17 and updated on 12/8/17 revealed, (Resident 54) is at risk for has (sic) nutritional problems r/t Dementia with behavioral disturbance. One of the goals developed was, Will maintain adequate nutritional status as evidenced by maintaining weight with no s/sx of malnutrition through review date. An intervention developed was, Provide assistance or cueing with meals as needed. On 1/11/18 at 2:42 PM, an interview was conducted with CNA 8 and Licensed Practical Nurse (LPN) 3. CNA 8 and LPN 3 stated that resident 54 required verbal cueing with eating. CNA 8 and LPN 3 stated that resident 54 refused to be fed and then not eat if a bite was offered. CNA 8 and LPN 3 stated that resident 54 will eat when verbally cued or when silverware was placed into resident 54's hand. On 1/16/18 at 12:44 PM, an interview was conducted with the RD. The RD stated that resident 54 needed verbal cueing. The RD stated that residents needed to be cued or provided assistance when their meals were served. 5. Resident 7 was admitted to the facility on [DATE] and readmitted on [DATE] with [DIAGNOSES REDACTED]. On 1/9/18 the following observations were made during lunch service. a. 12:09 PM: Resident 7 was served her meal. A CNA was observed to cut resident 7's food for her and cue her to eat. b. 12:14 PM: Resident 7 was observed to have one bite of food and then look around the room. c. 12:28 PM - 12:32 PM: Resident 7 was observed to have eight more bites of food. Resident 7 was not observed to be cued to eat again during the meal. On 1/10/18 from 7:47 AM to 8:47 AM, during breakfast service, the following observations were made. a. Resident 7 was observed to be pushing her toast around on her plate with her fork. b. 8:27 AM: A CNA was observed to offer to cut resident 7's toast for her. Resident 7 refused. Resident 7 was observed to consume a bite of her eggs and drink her milk. Resident 7 was not observed to be cued to eat again during the meal. On 1/11/18 from 7:45 AM to 8:31 AM, during breakfast service, the following observations were made: a. 7:45 AM: Resident 7 was sitting in her wheelchair in the dining room. b. 8:12 AM: Resident 7 was served a plate of scrambled eggs, hash browns, toast, hot cereal and a strawberry mighty shake. c. 8:20 AM: Resident 7 was sitting at the table with her left arm propped up on the wheelchair arm. Resident 7's head was leaned up against her hand. Resident 7 had not received cueing or assistance with eating. d. 8:24 AM: Resident 7 was cued by a tablemate, followed by a CNA to eat her breakfast. The CNA handed a strawberry mighty shake to resident 7 to drink. On 1/17/18, a review of resident 7's medical record was completed. Resident 7's most recent weight on 12/21/17 was 99 pounds. Resident 7's BMI was 15.3. Resident 7's care plan for nutrition revealed that resident 7 had increased needs to support weight gain. Resident 7's interventions for weight gain included, to cue resident 7 and provide assistance as needed during meals. On 1/17/18 at 9:00 AM, CNA 2 was interviewed. CNA 2 stated that resident 7 needs continuous encouragement throughout meals to eat. CNA 2 stated that resident 7 usually ate more at breakfast. CNA 2 stated that when resident 7 did not eat much of her meal she would be offered an alternate, usually resident 7 was more accepting of desserts and sweets. On 1/17/18 at 9:05 AM, CNA 1 was interviewed. CNA 1 stated that most of the time resident 7 ate really well and other times she just needed encouragement. | 2020-09-01 |