Initial Comments:
A focused fundamental survey visit was completed on October 28 and 29, 2024.
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 five, and the sample consisted of
three 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 interviews with the administrative staff, the facility failed to provide each individual with a nourishing, well-balanced diet including modified and specially prescribed diets for one of one sample individuals who is prescribed specialized diet of 6 small meals a day. This practice is specific to Individual #1.
Findings included:
1. Observation of the dinner meal on 10/28/2024 between approximately 5:00 PM through 5:30 PM revealed that at approximately 5:00 PM Individual #1 was seated in his wheelchair at the dining room table for dinner. Staff served him approximately 1 cup of pureed chicken, 1 cup pureed broccoli, and 1 cup of pureed potatoes on his plate, and then served thickened orange juice a bowl and placed it in front of Individual #1. Staff then sat beside Individual #1 and fed him 100% of his meal and thickened juice.
2. A review of the record of Individual #1 was completed on 10/28/2024 between 9:00 AM and 10: 00 AM. In a review of a document titled "IDT Meeting Notes" dated 8/28/2024, this document outlined two episodes of recent vomiting reported to nursing. Nursing services reviewed indicated that there would be follow up with the physician at Individual #1's Annual Physical in September 2024.
A review of the Annual Physical dated 09/23/2024 noted that Individual #1 is on a
2000 calorie regular diet , level one (pureed) diet with nectar thick or honey think liquids by spoon for his diagnosis of Dysphagia and Gastroesophageal reflux disorder (GERD). Additionally special instructions were added at this exam that Individual #1 will have 6 smaller meals per day due to episodes of vomiting reported to house nurse. The primary care physician also recommended follow up with the Gastroenterologist.
Further review of the record revealed a medial visit form for Gastroenterology dated 10/03/2024 which stated "continue 6 smaller meals/day, diet [recommendations] for gastroparesis provided. "
A review of the menu posted at the facility for Individual #1 was completed on 10/29/2024 between 9:00 AM and 9:30 AM. This document was titled Menu for Fall/Winter 2024 - 2025, 2000 calorie -pureed Level 1-GERD Menu -Week 4. This menu lists days of the week Sunday through Saturday. It also lists the following meals:
1)Breakfast
2)Lunch
3)Dinner
snack
There was no delineation within this menu to provide for the six small meals daily as listed on the annual physical completed by the primary Physician and confirmed by the Gastroenterologist during the visit on 10/03/2024.
Interview with the Program Director on 10/29/2024 at approximately 11:00 AM, confirmed there is no evidence that Individual #1 is getting the prescribed diet of six small meals daily and the current diet menu posted at the house is does not reflect this diet order.
Subsequent interview with the Director of nursing on 10/29/2024 at approximately
11:15 AM confirmed the above information from the Program Director.
Plan of Correction:CE #1: On 10-29-24, the Director of Nursing obtained a menu from the dietician for individual #1 to specifically address the prescribed diet of six small meals prescribed by the primary care physician and the gastroenterologist on 10-03-24. This menu was immediately put in place at the house on 10-29-24. The house nurse retrained on the new menu on 10-29-24. Documentation is the Menu from the dietician.
CE #2: By 11-29-24 the House Nurse will retrain the Program Coordinator, House Manager, and staff on each individual that resides at this home's physician ordered diets. The training will include a review of each menu from the dietician for all five individuals that reside in the house. Documentation will be an Individual specific IDT meeting note.
CE #3: At every scheduled meal (six times a day/seven days a week) the staff will document meal completion for individual #1. The HM will do random and unannounced observations during the weekdays and the weekends to ensure that staff are following the six small meals for Individual #1. Observations will occur during different mealtimes. The HM will review the menu for Individual #1 twice weekly to ensure all documentation is completed. Any missing documentation or incorrect documentation will be immediately addressed with the associate. The HM will bring the documented and reviewed menus for individual #1 to the Program coordinator at the end of each week for review. Documentation will be on the Individual #1 specific dietary menu.
CE #4: The Program Coordinator will do twice monthly random and unannounced observations during the weekdays to ensure that staff are following the six small meals for Individual #1. Observations will occur during different mealtimes. At the end of each week the HM will bring the documented and reviewed menus for Individual #1 to the Program Coordinator for review. The Program Coordinator will review the menus weekly and sign and date after the document has been reviewed for completion by the staff and the House Manager. The program coordinator will review the documentation and provide the House manager with any feedback. Documentation will be on the Individual #1 specific dietary menu.
CE #5: The Program Director will review all documentation associated with this plan of correction within a week of the completed documentation on the individual #1 specific menu. Any missing documentation or incorrect documentation will be immediately addressed with the associate responsible and documented. Documentation will be on the Individual #1 specific dietary menu.
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