HospitalInspections.org

Based on staff interview and medical record review, the hospital failed to ensure that the Director of Food Services established written clinical assessment procedures that were standardized and consistently applied for all patients (including Patient 194 admitted to the Laguna Campus), and monitored policies related to the retention of food products in accordance with manufacturer's recommendations. Failure to apply policies consistently may result in delayed nutrition interventions for patients identified at high nutritional risk patients at the Laguna Campus.

Findings:

1. On 10/9/12 at 1005 hours, review of the medical record for Patient 194 at the Laguna Campus showed the patient was admitted on 10/5/12. The patient was admitted with skin tears/wounds to the upper/lower extremities, dehydration, a history of 3-4 days of nausea and vomiting and a poor appetite.

On 10/6/12, the Nutrition Care Assistant documented a significant 20 pound (14%) weight loss in the past six months, and referred the patient to the RD for a nutritional assessment based on a nutrition risk "point" status of 12. Patients accumulating five or more nutrition risk points were referred to the RD for follow-up.

Further review of the medical record showed the patient was not assessed by the RD until 10/8/12.

On 10/9/12 at 1245 hours, review of the hospital policy titled "Nutrition Assessment of Patients" dated August 2012, showed the following: "All level III patients and patients referred to the Dietitian by Nursing and/or Nutrition Assistant will receive a nutrition assessment by the Dietitian. The assessment will be completed no later than 8:00 pm the day following notification at Mission Viejo campus and within 72 hours at Laguna Beach campus." In a concurrent interview with RD 4 and the Assistant Director of Nutrition Care Services, they could not explain why the RD assessment requirements would differ by campus if the nutrition risk level is the same. The Assistant Director of Nutrition Care Services stated the hospital would have to look at scheduling of RDs at the Laguna Campus.

2. On 10/8/12 at 0900 hours, during a tour of the kitchen at the Mission Viejo campus, there were approximately 10 quart cartons of pasteurized liquid egg product in the walk-in dairy refrigerator. The product was imprinted with a manufacturer recommendation to "Keep Frozen." The product was not dated as to when it was placed in the refrigerator. In a concurrent interview with the Director of Food Services, he stated that once removed from the freezer to thaw, the product would be retained for three days before discarding. He acknowledged that without being dated as to when it was taken out to thaw, it would be difficult for staff to discern the three day mark.

Review of the hospital's policy titled "Food Labeling Standards" showed for Refrigerated Foods, "TCS (Time/Temperature Control for Safety) Foods - 3 days."



16614