Health inspection·December 13, 2023

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to provide special eating equipment and utensils for residents who need them and appropriate assistance to ensure that the resident can use the assistive devices when consuming meals for 1 (Resident #1) of 5 residents reviewed for special eating equipment and assistance when consuming meals, in that: Residents Affected - Few The dietary staff failed to provide Resident #1 with a plate guard to meet Resident #1's need for assistance with eating related to Resident #1's right side weakness. This failure could place residents at risk for harm by weight loss, diminished independence, and self-esteem. The findings included: A record review of Resident #1's admission record dated 12/11/2023 revealed an admission date of 07/21/2023 with diagnoses which included hemiplegia following cerebral infarction [ right sided paralysis after a stroke]. A record review of Resident #1's quarterly MDS assessment dated [DATE] revealed Resident #1 was a [AGE] year-old male admitted for long term care and assessed with a BIMS score of 06 out of a possible score of 15 which indicated severe cognitive impairment. A record review of Resident #1's care plan dated 12/11/2023 revealed Resident #1 was to have a plate guard attached to his meal plate [a device that clips around the edge of the plate where a person can scoop food against using only 1 hand]. During an observation on 12/11/2023 at 12:02 PM revealed Resident #1 seated in the dining room with a plate of food before him. Continued observation revealed resident #1 was not eating but just sat staring at the plate of food. Further observation revealed there were no assistive devices for facilitation of eating on the plate and or table. A record review of Resident #1's meal ticket upon the table revealed Resident #1 was to have a plate guard on the plate, Adaptive Equipment: Plate Guard. During an interview on 12/11/2023 at 12:03 PM Resident #1 stated he was not eating due to the food being cold after he could not scoop his food. Page 1 of 2 675896 675896 12/13/2023 River City Care Center 921 Nolan St San Antonio, TX 78202

F 0810 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 12/11/2023 at 12:05 PM the food service manager stated Resident #1 was to have a plate guard on his plate to assist Resident #1 develop independence with eating his meal. The FSM stated there was no plate guard and removed Resident #1's meal and had Dietary Aide A prepare a new lunch meal to include the plate guard. During an observation and interview on 12/11/2023 at 12:11 PM revealed Resident #1 eating his meal from the plate affixed with a plate guard. Resident stated he was enjoying his meal, stated it's good. During an interview on 12/12/2023 at 4:45 PM the FSM stated Dietary Aide A was responsible to ensure residents, including Resident #1, received their meals as printed out on their meal tickets. The FSM stated Resident #1's meal ticket called for a plate guard to which Dietary Aide A did not read and or recognize and did not provide the assistive device. The FSM stated assistive devices help Resident consume their meals and develop independence and build self-esteem. The FSM stated the risk to residents who do not receive their meals which meet their dietary needs was possible weight loss, diminished independence, and diminished self-esteem. The FSM stated he would develop an in-service to provide further education and set expectations for the dietary staff to ensure residents receive their meals to meet their individual needs. The FSM stated he and the staff were responsible to ensure residents meals met their needs prior to the meal leaving the kitchen. A record review of the facility's Nursing Responsibilities at Meal Services policy dated 2012, revealed, Nursing services will cooperate with the dietary department to ensure that each resident is served according to regulations. The use of properly trained and supervised volunteers, family members, and other individuals can enhance the quality of life and the quality of care for residents. Procedure: Nursing service associates should follow these guidelines regarding meal service: .adapt space and equipment to assist residents in maintaining independent functioning, dignity, well-being, and self-determination .if a resident has a critical care need related to their ability to consume and process food, that resident should receive assistance from appropriately trained and experienced staff and or individuals. The facility needs to address these concerns when conducting the resident assessment and the required services should be included in the resident's care plan. 675896 Page 2 of 2