Initial Comments:
A focused fundamental survey visit was completed on April 21 and 22, 2022. The purpose of this visit was to evaluate compliance with the requirements of 42 CFR, Part 483, Subpart I regulations for Intermediate Care Facilities for Individuals with Intellectual Disabilities. The census at the time of the visit was four, and the sample consisted of two individuals.
Plan of Correction:
483.480(a)(1) STANDARD
FOOD AND NUTRITION SERVICES
Name - Component - 00
Each client must receive a nourishing, well-balanced diet including modified and specially-prescribed diets.
Observations:
Based on observation, record review and interview with administrative staff, the facility failed to ensure that each client received a nourishing, well-balanced diet including modified and specially-prescribed diets for one of two sample Individuals. This practice is specific to Individual #1.
Findings include:
1. A review of the facility's incident reports waa completed on 04/22/2022 from approximately 8:30 to 9:30 AM, and revealed the following information:
On 12/02/2021,at approximately 7:15 PM, a staff person asked Individual #1 if he wanted to get changed and this individual responded that he would. When the staff arrived at Individual #1's bedroom, he immediately called for the house manager to call 911. The staff person began performing the Heimlich maneuver, as Individual #1 went limp, was turning blue and pointing to his throat. 911 instructed the staff to start CPR and the AED was used.
911 arrived and took over. Individual #1 was awake and talking when leaving the house with the EMT's. Upon arrival at the hospital, Individual was in respiratory arrest presenting with hypoxic respiratory failure. He was placed on a ventilator to give his body a rest and admitted to ICU. Individual #1 was treated for aspiration pneumonia. He was taken off the ventilator on 12/05/2021, and was breathing using room air. A swallow study was completed at the hospital during this stay, and upon discharge, Individual #1's diet was changed to mechanical soft diet and thin liquids.
2. A review of Individual #1's record was completed on 04/22/2022 from 9:45 AM to approximately 11:30 AM, and revealed the following information:
-A speech evaluation dated 03/30/2022, revealed Individual #1 is on a mechanical soft diet with pureed meats, with instructions to alternate solid and liquids during his meal.
-An annual physical dated 03/15/2022, revealed Individual #1 is on a Level 2, mechanical soft diet with pureed meats.
- 90 Day Physician's Orders dated 04/18/2022, revealed Individual #1 is on a mechanical soft diet with pureed meats.
-Within an Individual program plan dated 02/22/22,on page 5 under the title Nutrition section,it states that Individual #1 was on a Level 4 regular diet, no modifications with thin liquids.
3. Observations completed on 04/21/2022 from approximately 5:00 PM to 5:30 PM revealed that Individual #1 was served a meal that consisted of chopped meatloaf, and mashed potatoes. This individual was offered gravy and pureed spinach, but refused to take any of these food items. He had a large travel cup with a straw inserted into the lid which contained fruit punch. Individual #1 ate all of the mashed potatoes and some of the chopped meatloaf before he was prompted to take a sip of his drink.
Interview on 04/22/2022 from approximately 10:30 AM to 10:32 AM with the Program Director of ICF/ID, who was present at the facility during meal time on 04/21/2022 from approximately 5:00 PM to 5:30 PM, confirmed that Individual #1's meatloaf was not puree,d and acknowledged that item should have been pureed prior to serving to Individual #1.
Plan of Correction:Core Element #1: On 4-22-22, the ICF Program Director retrained the QIDP on the requirement that individuals must receive meals as indicated on their physician's orders in the consistency required by their physician. On 4-22-22, the QIDP retrained the Home Manager and all current staff on the requirement that individuals must receive meals as indicated on their physician's orders in the consistency required by their physician. New staff will be trained as they start working in the home. Documentation will be the Mealtime Protocol Training Form for Individual #1.
Core Element #2: By 5-13-22, the ICF Program Director, QIDP, Nurse and Home Manager will meet to review each individual that resides at this home and discuss specifically if there are any additional specific dietary requirements that need to be addressed or initiated in addition to ensuring that the menu is followed at all times and that all items on the menu are prepared and served. Examples are ensuring that the specific prescribed diets are correct, reviewing caloric intake to ensure it is adequate and ensuring consistency of food and drink is appropriate upon a re-review by the nurse during the meeting. Any suggestions resulting from these meetings will be shared with the individual(s)' PCP. Documentation will be via IDT Meeting Notes.
Core Element #3: At each meal, the staff will prepare and serve the menu items as indicated on the menu in the consistency indicated. Each day, for each individual, at each meal time, staff will document the food and drink consistency that each individual received. Documentation will be the Meals Served Tracking Form.
Core Element #4: Three times per month, the QIDP will do random and unannounced observations of staff serving a meal to ensure that staff are preparing all items on the menu and in the correct consistency. While in the home, the QIDP will review all Meals Served Tracking Forms completed by staff since the QIDP's last unannounced observation to ensure that the diet consistencies have been followed. If the QIDP observes any concerns during their observations, they will address them at that time and notify their supervisor. Concerns observed will be documented on the observation form. Documentation will be the QIDP's signature, date and notes on the Meals Served Tracking Forms and the Mealtime Observation Forms completed by the QIDP and Home Manager.
Core Element #5: Once per month, the ICF Program Director will review the Mealtime Protocol Training Forms, IDT Meeting Notes, Meals Served Tracking Forms and the Mealtime Observation Forms to determine if the documentation indicates that dietary consistency orders are being followed and that trainings and observations have occurred as required. If there are any areas of concern, the ICF Program Director will retrain the QIDP and the QIDP will retrain the Home Manager and all staff. Documentation will be the ICF Program Director's signature on each documentation form.
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