Other·December 1, 2023

F692 Code of Federal Regulations, Title 42, Section §483.25(g) Assisted nutrition and hydration. (Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident- §483.25(g)(1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise; §483.25(g)(2) Is offered sufficient fluid intake to maintain proper hydration and health; §483.25(g)(3) Is offered a therapeutic diet when there is a nutritional problem and the health care provider orders a therapeutic diet. California Code of Regulations, Title 22, Section 72315, Nursing Service – Resident Care (h) Each Resident shall be provided with good nutrition and with necessary fluids for hydration. On 11/19/2023 at 8 am., the California Department of Public Health conducted an unannounced recertification survey. As a result of the investigation, the Department determined the facility failed to implement the Registered Dietitian's (RD) recommendations to prevent weight loss for Resident 68 by failing to provide Resident 68 Boost (nutritional drink) with high protein nourishment four times a day. As a result of these failures, Resident 68 experienced weight loss and these failures had the potential to result in significant weight loss. During a review of Resident 68's Admission Record (AR), the AR indicated Resident 68 was a 75-year-old female and was admitted to the facility on 3/18/22 with diagnoses that included unspecified dementia without behavioral disturbance (a group of thinking and social symptoms that interferes with daily function), bilateral primary osteoarthritis (breakdown of cartilage in the joint with no known cause), and unspecified psychosis (loss of touch with reality). During a record review of the Weight Loss Monthly Report, dated, 4/23 to10/23, the Weight Loss Monthly Report indicated Resident 68's weight on 9/1/23 was 118 pounds (lbs., unit of measurement) and on 10/1/23 Resident68’s weight was 113 lbs. Resident 68 lost 5 lbs. in 30 days for a total of 4.3 percent weight loss. During a review of Resident 68's Minimum Data Set (MDS, a Resident assessment and care screening tool) dated 9/22/23, the MDS indicated Resident 68 had severe impaired cognition (ability to understand and process information) and required supervision with mobility and limited to extensive assistance with Activity of Daily Living (ADL, term used in healthcare that refers to self-care activities). During a record review of the RD Nutrition Consult Report, dated 10/4/23, the RD Nutrition Consult Report indicated a recommendation to change the oral nutritional supplement (ONS) to Boost 4 cartons daily to help meet Resident 68’s estimated nutritional needs. During an interview on 10/18/23, at 1:52 p.m., with the RD, the RD stated, "significant weight loss is 5 percents (%) weight loss in 30 days" and/or plus or minus 5 pounds (lbs.) in 30 days, 7.5% weight loss in 3 months, or 10% weight loss in 6 months. The RD stated Resident 68's dietary needs were assessed, and the nutrition assessment was completed on 10/4/23. The RD stated on 10/4/23, the RD increased Boost with high protein nourishment to four times a day from Boost with meals which is three times day for Resident 68. During an interview on 10/18/23, at 2:25 p.m., with the RD, the RD stated currently, Resident 68's weights were obtained monthly. The RD stated the next weight would be in a month and there was no weekly weight order in place. During a subsequent interview on 10/18/23, at 2:29 p.m., with the RD, the RD stated at the end of the visit day, the nutritional assessment was communicated by email to the Food Service Manager, the MDS Nurse, the Director of Nursing (DON), the Administrator (ADM), and the Medical Records. During a subsequent interview on 10/18/23, at 2:33 p.m., the RD stated the RD would recommend obtaining weekly weights for Resident 68. During an interview and concurrent record review of the Order Summary Report on 10/19/23, at 2:04 p.m., with Registered Nurse (RN 1), RN 1 stated RN 1 did not see the Physician Orders were updated with the RD's recommendation to increase Boost with high protein nourishment to four times a day as of 10/19/23. During a concurrent interview with RN 1 on 10/19/23, at 2:28 p.m., RN 1 stated Resident 68's Care Plan was revised on 10/16/23 with the dietary recommendations. During a record review of the Order Summary Report, dated 10/19/23, the Order Summary Report indicated Resident 68's current diet was a regular diet, mechanical soft/chopped meat texture, thin liquid, high protein nourishment twice a day, and Boost with meals. The diet did not include the RD's dietary recommendation to increase Boost with high protein nourishment to four times a day. Resident 68's daily meal intake documentation was requested and not provided by the facility. During a review of the facility's policy and procedure (P&P) titled, "Weight Assessment and Intervention," dated May 2023, indicated "Resident weights are monitored for undesirable or unintended weight loss or gain." As a result of the investigation, the Department determined the facility failed to implement the Registered Dietitian's recommendations to prevent weight loss for Resident 68 by failing to provide Resident 68 Boost with high protein nourishment four times a day. As a result of these failures, Resident 68 experienced weight loss and these failures had the potential to result in significant weight loss. The above violation, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Resident 68.