Initial Comments:
A focused fundamental survey was conducted May 23-24, 2023, to determine compliance with the requirements of the 42 CFR Part 483, Subpart I Regulations for Intermediate Care Facilities. The census during the survey was five and the core sample consisted of three individuals.
Plan of Correction:
483.480(b)(2)(iii) STANDARD
MEAL SERVICES
Name - Component - 00
Food must be served in a form consistent with the developmental level of the client.
Observations:
Based on observation, record review, and interviews, it was determined that the facility failed to provide food in a form consistent with the developmental level of the individuals. This applied to two (#2 and #4) of five individuals living at the residence. Findings included:
1. Morning observations were completed at the residence on May 23, 2023, from 5:35 AM to 7:45 AM. During this time, Individual #2 was observed to consume cereal with their breakfast meal that appeared to be prepared with unthickened milk. The staff then prepared Individual #2's coffee using thickener. At 7:01 AM, the surveyor questioned the staff regarding the consistency of the cereal milk and the staff confirmed that the milk in the cereal was not thickened. The staff then prepared a new bowl of cereal with thickened milk.
A record review for Individual #2 was completed on May 24, 2023. This review revealed a current physician's order, signed April 18, 2023, with a diet order that stated: "nectar thick liquids by cup or spoon."
2. Morning observations were completed at the residence on May 23, 2023, from 5:35 AM to 7:45 AM. At 6:20 AM, Individual #4 was observed to consume cereal with milk that didn't appear to be thickened. Observations of the morning medication pass were completed from 6:37 AM to 6:47 AM. During this time, Individual #4 was observed to receive their morning medications with water that was observed to be thickened by the staff passing the medications. At 7:01 AM, the surveyor questioned the staff regarding the consistency of the cereal milk and the staff confirmed that the milk had not been thickened in Individual #4's breakfast cereal earlier that morning.
A record review of the current physician's order, signed April 18, 2023, for Individual #4 was completed on May 24, 2023. This review revealed a diet order that stated: "nectar thick liquids only."
An interview with the house manager (HM) was completed at the residence on May 23, 2023, at 7:44 AM. The HM confirmed that Individual #2 and Individual #4 should have received nectar thickened liquids, including the milk used for breakfast cereal.
An interview with the administrator on May 23, 2023, at 9:30 AM, confirmed that Individuals #2 and #4 did not receive their food in a form consistent with their developmental levels. The administrator further confirmed that all liquids for Individuals #2 and #4 should be nectar thickened, including the milk used for breakfast cereal.
Plan of Correction:Merakey/Allegheny Valley School (AVS), 195 Wildwood Dr, makes its best efforts to operate in full compliance with both Federal and State law. Nothing included in this Plan of Correction is an admission otherwise. AVS, 195 Wildwood Dr., has submitted this Plan of Correction to comply with its regulatory obligation and does not waive any objections to the merits or form of any allegations contained herein. Please note that AVS, 195 Wildwood Dr., may contest the merits and/or form of any deficiency or finding alleged below and take reasonable steps to appeal them.
TAG 0474 – MEAL SERVICES
For the affected Individuals #2 and #4, the staff person involved in the incident on the date of May 23, 2023, was immediately retrained on her next scheduled shift, of the feeding profile. For potentially affected individuals at 195 Wildwood Dr, all staff at the site will be retrained on current feeding profiles for all individuals that reside at the site. This was facilitated by the Administrator and completed on 5/27/23.
An in-service for all House Mangers in the Allegheny/Beaver County area will be completed during the month of June that will include reviewing current feeding profiles being followed as outlined by the Occupational Therapist. House Managers will be directed to pay special attention to food textures and liquid consistencies. This in-service will be completed by the Occupational Therapy department.
In addition, an observation for all ICF individuals that utilize thickened liquids in the Allegheny/Beaver County Group Homes will be completed. These observations will be completed at breakfast time, for a total of 16 observations. Observations will be conducted by the House Managers or designee. Reports will include if proper implementation of feeding profiles were observed. Results of these observations will be sent the site Administrator who will be the responsible party for any issues that arise.
Monitoring of this concern will include observations for individuals that reside at 195 Wildwood. It will include observations of mealtime, at varying meals (breakfast, lunch & dinner), once a month for a 3-month period totaling 3 observations. Observations will be conducted in an alternating fashion by the QIDP, Motor Development Specialist and the Administrator. This will begin during the month of June 2023 and will continue until August 2023. Reports will include if proper implementation of feeding profiles were observed. Results of these observations will be sent the site Administrator who will be the responsible party for any issues that arise.
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