Health inspection·May 23, 2024

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 medical record review, staff interview and policy review, the facility failed to notify the physician or nurse practitioner regarding significant weight loss and ensure the dietitian's recommendations for weight loss were addressed. This affected two (Residents #63 and #66) of three residents (#57, #63 and #66) who were identified as having an unplanned weight loss. The facility census was 79. Residents Affected - Few Findings include: 1. Record review revealed Resident #63 was admitted on [DATE] with diagnoses that included but were not limited to displaced intertrochanteric fracture of left femur, anxiety disorder, and dementia. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #63 had moderately impaired cognition and was independent for eating. Review of Resident #63's recorded weights revealed the following: 05/09/24 - 96.0 pounds (lbs). which was a 9.09 percent (%) weight change in less than 30 days and 18.64 % change over 180 days. 04/03/24 - 105.6 lbs. 03/21/24 - 107 lbs. which was a 6.14 % weight change in less than 30 days. 03/12/24 - 114.5 lbs. 11/21/23 - 118.0 lbs. Review of the nutritional documentation dated 02/11/24 and 02/23/24 revealed Registered Dietitian (RD) #206 made recommendations for an appetite stimulant. Further review of the medical record and review of physician's progress notes revealed that Resident #63's significant weight loss was not evaluated or addressed by the physician or nurse practitioner and the appetite stimulant that Registered Dietitian #206 recommended was not addressed. Interview on 05/23/24 at 11:21 A.M. with Registered Dietitian (RD) #206 revealed she recommended an appetite stimulant on 02/11/24 and 02/23/24 for Resident #63 but nursing did not communicate her recommendations to the physician or nurse practitioner. RD #206 stated she thought nursing informed the physician or nurse practitioner about weight loss. Page 1 of 2 366463 366463 05/23/2024 Avenue at Wooster 1700 East Smithville Western Road Wooster, OH 44691

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation of the lunch meal service on 05/23/24 at 12:10 P.M. revealed Resident #63 was receiving cues to eat from staff. Interview on 05/23/24 at 12:44 P.M. with the Director of Nursing (DON) revealed that she spoke to Nurse Practitioner (NP) #209 and NP#209 stated she was not aware of any weight loss for Resident #63. The DON stated that she thought RD #206 notified the doctor and RD #206 thought nursing notified the doctor. Review of the facility policy with a revision date of 12/2022 revealed there should be a documented clinical basis for any conclusion that nutritional status or significant weight change were unlikely to stabilize or improve (e.g. Physician's documentation as to why the weight loss was medically avoidable). 2. Record review revealed Resident #66 was admitted on [DATE] with diagnoses that included but were not limited to morbid obesity, diabetes mellitus, and major depressive disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #66 had moderately impaired cognition and was independent for eating. Review of Resident #66's recorded weights revealed the following. 05/09/24 - 293.0 pounds (lbs.) which was a 16.29 percent (%) weight change in less than 30 days. 04/03/24 - 331.3 lbs. Review of the nutritional documentation revealed Registered Dietitian (RD) #206 was aware of and monitoring Resident #66's weight loss. Further review of the medical record and review of physician's progress notes revealed that Resident #66's significant weight loss was not evaluated or addressed by the physician or nurse practitioner. Interview on 05/23/24 at 11:21 A.M. with Registered Dietitian (RD) #206 revealed Resident #66 had a significant weight loss and RD #206 had recommended that the former dietary manager update Resident #66's food preferences because Resident #66 ate a big breakfast and then picked the rest of the day. RD #206 stated that she thought nursing informed the physician or nurse practitioner about weight loss. Interview on 05/23/24 at 12:44 P.M. with Director of Nursing (DON) revealed that she spoke to Nurse Practitioner (NP) #209 and NP#209 stated that she was not aware of any weight loss for Resident #66. The DON stated that she thought RD #206 notified the doctor and RD #206 thought nursing notified the doctor. Review of the facility policy with a revision date of 12/2022 revealed that there should be a documented clinical basis for any conclusion that nutritional status or significant weight change were unlikely to stabilize or improve (e.g. Physician's documentation as to why the weight loss was medically avoidable. This deficiency represents non-compliance investigated under Complaint Number OH00153099. 366463 Page 2 of 2