Health inspection·March 8, 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 observation, interview, and record review, the facility failed to offer, based on resident's comprehensive assessment, a therapeutic diet when there was a nutritional problem, and the health care provider ordered a therapeutic diet for 2 of 5 residents (Residents #1 and #2) reviewed for therapeutic diets. Residents Affected - Some The facility to ensure Resident #1 and Resident #2 received fortified meal plan as ordered by their physician. This failure could place residents who are on a modified diet at risk of weight loss and decline in health status. Findings Included: Resident #1 Record review of Resident #1's face sheet dated on 03/08/2024 revealed he was an [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included dementia (memory loss), hyperlipidemia (high level of fat in the blood), protein calorie malnutrition (inadequate intake of food such as protein, starch, and nutrients), muscle weakness, essential hypertension (high blood pressure), hypothyroidism (when the thyroid glands does not produce enough thyroid hormones), iron deficiency anemia (lack of sufficient healthy red blood cells in the blood), oropharyngeal phase (chewing and transferring of food through the oral cavity), abnormalities of gait(walking disorder), encounter for attention to gastrostomy (opening in the stomach), altered mental status (confusion, disorder), major depression (affects how you think, feel and behave), adult failure to thrive (decline in health and ability to gain weight), insomnia (sleep disorder), vitamin D deficiency (lack of vitamins), constipation (difficulty passing stool) and myocardial infarction (blockage of blood flow to the heart). Record review of Resident #1's quarterly MDS dated [DATE] revealed a BIMS score of 03 indicating she was severely impaired for cognitive skills for decision making. For swallowing and nutritional status, she was coded as having no swallowing problems or weight loss of more than 5%. For nutritional approaches the resident was feed via a feeding tube and was on a mechanical altered diet. Record review of Resident #1's care plan dated 2/20/2024 revealed the following: Focus: Resident has unplanned/unexpected weight loss. Goal: To have Resident regain lost weight. Intervention: Alert Dietitian if consumption is poor for more than 48 hours. Give supplement as ordered. Page 1 of 3 675344 675344 03/08/2024 Paradigm at Sweeny 109 N McKinney Sweeny, TX 77480

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of physician's order dated 2/19/2024 revealed an order for regular diet, mechanical soft texture regular liquid thin consistency. Fortified foods related to mild protein-calorie malnutrition. Observation on 03/08/2024 at 12:20pm revealed Resident #1 in the dining room for lunch she was self-fed. Resident#1's meal consisted of starch, protein and vegetables with thin liquid water and iced tea. No fortified soup was observed on Resident#1's tray. Resident#1's meal looks exactly like all the other resident who were getting regular mechanical meal. Further observation revealed Resident #1 ate about 75% of her meal. Resident #2 Record review of Resident #2's face sheet dated on 03/08/2024 revealed he was a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included esophageal obstruction (blockage in the esophagus), down syndrome (is a genetic disorder caused by abnormal cell division), gastrointestinal hemorrhage (disorder in the digestive tract), protein calorie malnutrition (inadequate intake of food such as protein, starch, and nutrients), muscle weakness(decreased strength in the muscles), and hypothyroidism (a condition where the thyroid glands doesn't produce enough thyroid hormones). Record review of Resident #2's quarterly MDS dated [DATE] revealed he was severely impaired for cognitive skills for decision making. For swallowing and nutritional status, he was coded as having swallowing problems, having weight loss of more than 5%. For nutritional approaches the resident was on a mechanical altered diet. Record review of Resident #2's care plan dated 5/23/2023 revealed the following: Focus: Resident requires a therapeutic diet, pureed diet for nutritional support and at risk for weight loss. Goal: To have adequate nutrition and free from unplanned weight loss: Intervention: Assist resident with eating. Give supplement as ordered. Record review of physician's order dated 8/24/2023 revealed an order for regular diet, pureed texture, regular liquid thin consistency, no thick food. Add fortified foods to meal, health shake with all meals. Observation on 03/08/2024 at 12:25pm revealed Resident #2 in the dining room for lunch he was assisted with eating. Resident#2's meal consisted of pureed starch, protein and vegetables with thin liquid water and iced tea. No soup was observed on resident #2's tray. Resident#2's meal looked exactly like the residents who were getting regular mechanical meal. Further observation revealed Resident #2 ate all his meal. In an interview on 03/08/2024 at 1:00pm with [NAME] A regarding the modified diet she said she did not prepare the fortified meal, because she did not have the ingredient to prepare the meal. She said when she did not prepare fortified meal, she would give the residents double portion. She was asked if she had given Resident #1 and Resident #2 fortified meal she said no, she said if they asked for more food, she would give them. In an interview with the Dietary Manager on 3/08/2024 at 3:20pm he said he was new to the facility. He said they have recipe for fortified meal plan, and he was going to ensure that fortified meals 675344 Page 2 of 3 675344 03/08/2024 Paradigm at Sweeny 109 N McKinney Sweeny, TX 77480

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some were prepared daily. At that point he called [NAME] A regarding fortified meal for lunch, and she told him she did not prepare any fortified meal for lunch, but she was going to prepare fortified meal for dinner. At that point the Dietary Manager said he would have to in-service the cooks on the importance of preparing meals as ordered. Further interview with [NAME] A on 03/08/2024 at 3:45pm she said fortified meal plan was supposed to help residents to gain weight. She said if residents were not getting fortified meals, they could lose weight. She said she was going to ensure that fortified meals were prepared daily. In an interview on 03/08/2024 at 4:45pm the Administrator said she was the one who ordered the food and the ingredients to prepare fortified foods. She said the food items for fortified recipe were available, but the cook did not ask for them. She said she will have to in-service the dietary staff. She said the Dietary Manager was new to the facility and he will work with the dietary staff to address the dietary issues in the kitchen. Record review of the undated facility's Fortified Food Schedule revealed the following: Breakfast: Fortified Cereal, Lunch: Fortified Soup, Dinner: Fortified potato or Fortified pudding. A variety of fortified foods are available. A variety of fortified food recipes are available through the menu system. Fortified foods served may deviate from this schedule with dietary manager approval. This schedule is a suggestion. The dietary manager may alter this schedule based on resident preference and product availability. 675344 Page 3 of 3