Health inspection·December 21, 2023

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of the medical record, interviews with staff, and facility policy review the facility failed to ensure Residents #81 and #33 received their supplements as ordered and failed to ensure Resident #14 received nectar thick liquids as ordered. This affected three residents (#14, #33, and #81) out of seven residents reviewed for nutrition. The facility census was 97. Residents Affected - Few Findings included: 1. Review of the medical record revealed Resident #81 was admitted to the facility on [DATE]. Diagnoses included osteomyelitis, pneumonia, mild proteins calorie malnutrition, diabetes, hypertension, chronic obstructive pulmonary disease, acute respiratory failure, vitamin D deficiency, heart failure, and dysphagia. Review of the weights in the medical record revealed on 11/07/23 Resident #81 weighed 101.6 pounds. Review of the weights in the medical record revealed on 12/13/23 Resident #81 weighed 93.3 pounds for an 8.3-pound weight loss in a month. Review of the progress notes dated 12/14/23 revealed Resident #81 had a weight loss of three pounds this week. Recommended adding sugar free Mighty Shake (nutritional supplement) twice daily to help meet her needs. Review of the physician's orders revealed Resident #81 had an order dated 12/14/23 for a sugar free Mighty Shake twice daily at 12:00 P.M. and 6:00 P.M. Observation on 12/20/23 at 5:15 P.M. revealed a staff member had taken the dinner tray for Resident #81 into her room and set it on the bedside stand beside her bed. Resident #81 was sleeping with her head rolled down. At 5:35 P.M. Resident #81 was still sleeping with the head of her bed rolled down. Her dinner tray was still on her bedside stand with the cover on it. Her meal ticket indicated she was to have six ounces of beef vegetable stew, one serving of alternate vegetable, half cup of mashed potatoes, one cup tossed salad with dressing, roll/bread, yellow cupcake with no frosting, and a four ounces Mighty Shake. She did not receive one serving of alternate vegetable, half cup of mashed potatoes, or the four ounces Mighty Shake. An interview at this time with Registered Nurse (RN) #724 verified she had not received her vegetables, mashed potatoes, or Mighty Shake on her tray. She stated she would find out why from the kitchen. Review of the facility policy titled, Diet Order Policy, dated 07/27/20, revealed the facility wound ensure residents were provided meals as ordered by their healthcare provider. Diet orders would Page 1 of 3 366403 366403 12/21/2023 Bath Creek Estates 186 West Bath Road Cuyahoga Falls, OH 44223

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few follow the facility formulary or an individualized diet as written and/or approved by the Registered Dietitian. The Food Service Manager would utilize a tray card identification system to ensure that each resident received his or her diet as ordered and the diet in the medical record matched the diet on the tray card system. 2. Review of the medical record revealed Resident #33 was admitted to the facility on [DATE]. Diagnoses included cerebral infarction, hemiplegia of the left side, dysphagia, atrial fibrillation, chronic obstructive pulmonary disease, convulsions, hypothyroidism, hydronephrotic, chronic pain syndrome, vascular dementia, major depressive disorder, and generalized anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #33 had intact cognition. She did not have any weight loss, and she received a mechanically altered diet. Review of the physician's orders revealed Resident #33 had an order dated 06/01/23 for 120 milliliters (ml) of Mighty Shake twice daily, and she had a regular pureed diet with nectar thick liquids. A dining observation on 12/18/23 at 1:10 P.M. revealed the meal ticket for Resident #33 indicated she was to have a four-ounce Mighty Shake. She had a one-two handle spouted cup with apple juice in it. She was not given or offered a Mighty Shake, and she was taken back to her room. An interview at this time with Licensed Practical Nurse (LPN) #703 verified she had not received her Mighty Shake and she would go get her one. A dining observation on 12/19/23 at 8:30 A.M. revealed the meal ticket for Resident #33 indicated she was to have a four-ounce Mighty Shake. She had a one-two handle spouted cup with apple juice in it. She was not given or offered a Mighty Shake, and she was taken back to her room. An interview at this time with the Director of Nursing (DON) verified she had not received her mighty shake, and she would go find out why she had not received it. Review of the plan of care dated 07/25/23 revised on 11/21/23 revealed Resident #33 had an increased nutrition/hydration risk related to hypertension, atrial fibrillation, coronary artery disease, cerebrovascular accident, chronic obstructive pulmonary disease, need for thickened liquids and mechanically altered diet. Interventions included providing supplements as ordered. Review of the facility policy titled, Diet Order Policy, dated 07/27/20, revealed the facility wound ensure residents were provided meals as ordered by their healthcare provider. Diet orders would follow the facility formulary, or an individualized diet as written and/or approved by the Registered Dietitian. The Food Service Manager would utilize a tray card identification system to ensure that each resident received his or her diet as ordered and the diet in the medical record matched the diet on the tray card system. 3. Review of the medical record revealed Resident #14 was admitted to the facility on [DATE]. Diagnoses included dementia, major depressive disorder, hypertension, seizures, hypothyroidism, benign prostatic hyperplasia, convulsions, basal cell carcinoma, heart failure, cerebral infarction, and dysphagia. Review of the physician's orders revealed Resident #14 had an order dated 05/23/23 for a regular diet with nectar thick liquids. Review of the annual MDS assessment dated [DATE] revealed Resident #14 had severely impaired 366403 Page 2 of 3 366403 12/21/2023 Bath Creek Estates 186 West Bath Road Cuyahoga Falls, OH 44223

F 0692 cognition, he had no weight loss and had a mechanically altered diet. Level of Harm - Minimal harm or potential for actual harm Review of the lunch meal ticket dated 12/18/23 revealed Resident #14 was to have nectar thick liquids, nectar thick coffee, and nectar thick apple juice. Residents Affected - Few A dining observation on 12/18/23 at 12:50 P.M. revealed the meal ticket for Resident #14 indicated he was to receive nectar thick liquids. Further observation revealed State Tested Nursing Assistant (STNA) #732 poured a regular thin consistency chocolate milk into a handled mug and gave it to him to drink. He took two drinks prior to the surveyor asking her if she had thickened the chocolate milk; she stated she had not, and she did not even know how to thicken the chocolate milk. An interview at this time with LPN#703 verified he should have nectar thick chocolate milk, and they had thickener packets to thicken the liquids that do not come already thickened. On 12/19/23 at 11:05 A.M. an interview with Food Service Manager #676 revealed the facility provided pre-thickened juices; however, the milk had to be thickened manually. If they do not have the pre thickened juices, then the staff thickens the juice with the thickener packets. She stated that the dietary department sends out thickener packets on the drink carts for all meals. Review of the facility policy titled, Diet Order Policy, dated 07/27/20, revealed the facility wound ensure residents were provided meals as ordered by their healthcare provider. Diet orders would follow the facility formulary or an individualized diet as written and/or approved by the Registered Dietitian. The Food Service Manager would utilize a tray card identification system to ensure that each resident received his or her diet as ordered and the diet in the medical record matched the diet on the tray card system. 366403 Page 3 of 3