Health inspection·July 7, 2023

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of a facility policy, the facility failed to change a resident's diet to a therapeutic diet as recommended by a dietician. This affected one (#10) of five residents reviewed for diets. The facility census was 46. Findings include: Review of Resident #10's medical record revealed an admission date of 05/18/23 and a discharge date of 05/30/23. Diagnoses included acute kidney failure, type II diabetes, hydronephrosis (excess fluid in the kidney), ulcerative colitis, and enterocolitis due to clostridium difficile not specified as recurrent. Review of Resident #10's Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 12 indicating Resident #10 was moderately cognitively impaired. Resident #10 required limited assistance with bed mobility, transfer, and dressing. Resident #10 required extensive assistance with toilet use and personal hygiene. Resident #10 displayed no behaviors during the review period. Review of Resident #10's care plan discontinued 06/01/23 revealed supports and interventions for effective communication, discharge plan to return home following the completion of therapy services, impaired skin integrity and nutrition risk. The supports and interventions for nutritional risk included to assist with meals as needed, dietician to re-evaluate as indicated, offer alternate food and beverage items as needed, and provide diet, supplements, medications, and adaptive equipment as ordered. Review of Resident #10's admission paperwork from the hospital dated 05/18/23 revealed Resident #10 was to be on a diabetic carbohydrate controlled diet. Review of Resident #10's physician orders revealed an order dated 05/19/23 for a regular diet with thin liquids. Review of the medical record revealed, on 05/22/23, it was noted Resident #10 was evaluated by the physician with Resident #10's daughters at the resident's bedside during the evaluation, and reported Resident #10 was not eating his dinner, was not getting what he ordered, and could not eat the things the facility brought to him. Resident #10 indicated the food items the facility provided to him raised his blood sugar levels too much. The physician noted the concerns would be brought to the nursing department's attention, and documented it was thought Resident #10 was having trouble ordering Page 1 of 2 366464 366464 07/07/2023 Springs of Lima The 370 North Eastown Road Lima, OH 45807

F 0808 food for himself. Level of Harm - Minimal harm or potential for actual harm Review of a progress note dated 05/23/23 revealed a nutritional assessment was completed by the dietician. It was noted Resident #10's diet order was for a regular diet with thin liquids. Resident #10's intakes were documented to be between 50 percent (%) and 100% of all meals since admission. It was recommended Resident #10 be changed to a controlled carbohydrate diet to help support his overall blood sugar level. Residents Affected - Few Review of Resident #10's nutrition assessment dated [DATE] revealed Resident #10 was on a regular diet. The dietician recommended Resident #10 be changed to a controlled carbohydrate diet to help support blood sugar levels; however, no diet change was found in the medical record. Further review of Resident #10's medical record revealed no diet order changes were found, and Resident #10 continued to receive a regular diet. Interview on 07/06/23 at 9:04 A.M., with the Director of Nursing (DON) verified Resident #10's diet order from the hospital documentation dated 05/18/23 was not the diet order that was implemented at the facility on admission. The DON verified there were no adjustments made to Resident #10's diet order following the dietician's recommendation for a change on 05/23/23. Review of the facility policy titled, Diet Order Communication- Nursing to Dining, revised 12/31/22, revealed it was expected the communication of diet orders between nursing and the dietary department take place. Nursing was to input physician prescribed diet orders into the electronic health record (EHR). The physician diet orders in the EHR were to be compared weekly in the dining tray card system to insure consistency. This deficiency represents non-compliance investigated under Master Complaint Number OH00143265 and Complaint Number OH00143071. 366464 Page 2 of 2