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Based on interview and record review, the facility failed to develop a comprehensive care plan, based on the nursing assessment, and with no evidence of review or revision of the care plan for 2 (#s 5 and 12) of 26 sampled patients. Findings include:

1. Review of patient #12's care plan, dated 4/8/23, showed she would:

- Understand the discharge plan, her medication dosages, and her self after care.
- Collaborate with the health care team for discharge needs.
- Understand her pain management.
- Understand VTE prophylaxis activities.

Care plan areas needed for resident #12 included history of pain medication addiction; mental health disease; inability to complete her activities of daily living including eating, toileting, and getting out of bed; dysphasia; requiring frequent small meals; weight loss; and at risk for amputation of toes and fingers.

During an interview on 4/26/23 at 3:20 p.m., staff member B stated the electronic health system the facility used made it difficult to implement a meaningful care plan. The staff tried to use their narrative notes as updates to the care plan.


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2. Review of patient #5's History and Physical, dated 2/6/23, showed the patient had an admitting diagnosis of severe protein calorie malnutrition and weight loss.

Review of patient #5's care plans, dated 2/6/23, failed to show documentation of nutrition or weight loss as areas of concern for patient #5. The only items of concern documented were related VTE prevention and discharge needs.

During an interview on 4/26/23 at 3:45 p.m., staff member B stated she was unable to find any care plan documentation related to patient #5's diagnoses of severe protein calorie malnutrition and weight loss. Staff member B stated there should have been care plan areas of concern related to nutrition and weight loss.

A request was made on 4/26/23 for care plan documentation for patient #5 related to malnutrition and weight loss. No care plan documentation was received prior to the end of the survey.

Based on observation, interview, and record review, the facility failed to follow the prescribed menu, and the therapeutic breakdown for 1 (#12) of 26 sampled patients. The deficient practice resulted in inadequate calorie intake, inadequate fluid intake, and weight loss for the patient. Findings include:

During an observation of the breakfast meal on 4/25/23 at 8:20 a.m., staff member N served one link sausage and a mound of scrambled eggs to each of the six hospitalized patients. The meal trays did not include meal tickets with names or diets. The menu for breakfast called for orange juice, toast, and hot cereal. Resident #12 asked for hot cereal. Staff member N left the room to prepare instant cereal.

During an interview on 4/25/23 at 8:20 a.m., patient #12 stated she was aware of the weight loss and it concerned her. She stated she could only eat small amounts of food at a time due to a gastric bypass surgery 20 years ago. She stated she was not able to access food throughout the day because the facility did not have an on-site kitchen. Patient #12 stated a refrigerator was provided for her, but she said she could not get up independently to get food items from the refrigerator. Patient #12 stated she was not able to feed herself due to septic and painful fingertips.

Review of resident #12's electronic health record showed she had lost four pounds since her admission on 4/6/23. Review of patient #12's prescribed diet order showed she should have received a dysphagia diet with minced meats and pureed vegetables. She received a whole sausage link for breakfast.

During an observation of breakfast on 4/26/23 at 8:10 a.m., the six patients did not receive, and were not offered, juice, milk, or hot cereal.

During an interview on 4/26/23 at 4:10 p.m., staff member C stated the facility had recognized there were food/dietary concerns and had a meeting on 4/21/23 to discuss the concerns with the food service management company. The concerns were to be monitored for quality improvement. Staff member C stated she did not know why the menu was not being followed.