§483.25(g) Assisted nutrition and hydration.
(Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident-
§483.25(g)(1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise;
§483.25(g)(2) Is offered sufficient fluid intake to maintain proper hydration and health;
§483.25(g)(3) Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet.
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Observations:
Based on clinical record review, facility policy review, and staff interview, it was determined that the facility failed to adequately monitor and assess weight loss for one of three sampled residents at risk for weight loss. (Resident 5)
Findings include:
Review of the facility policy entitled, "Weight Assessment and Intervention," last reviewed January 18, 2024, revealed that any weight change of five pounds (lbs.) or more from the last weight assessment would be retaken for confirmation. If the weight was verified, nursing staff would notify the dietitian. The dietitian or Certified Dietary Manager would review the individual weight records and make recommendations as appropriate.
Clinical record review revealed that Resident 5 had diagnoses that included osteoporosis and dementia. Review of the care plan revealed that the resident had a history of weight loss. On March 1, 2024, the resident weighed 127 lbs. On April 5, 2024, the resident weighed 117 lbs. The resident was reweighed on April 7, 2024, and weighed 120 lbs., which verified a weight loss of 7 lbs., (5.5 percent). There was a lack of evidence to support that staff notified the dietitian, or that the dietitian assessed the weight loss or resident's nutritional status until April 30, 2024, during a regularly scheduled quarterly assessment.
In an interview on December 5, 2024, the Administrator confirmed that there was no evidence that the dietitian was notified of the verified weight loss and that the dietitian should have assessed the resident prior to April 30, 2024.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
| | Plan of Correction - To be completed: 12/31/2024
Resident 5 weights to be reviewed for accuracy. Resident 5 assessment to be completed by dietician.
All resident weights and assessments to be reviewed for accuracy and timeliness for all current residents with a lookback review.
Resident weights to be reviewed to ensure follow up completed according to the facility policy. A random monthly audit of weights to be completed by nursing administration or designee monthly. Education provided to licensed nursing staff and dietician regarding the weight policy.
Findings from the audits will be reported to QAPI for 3 months.
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