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Based on interview and record review, the facility failed to ensure the supervision of nursing care involving the administration of ordered nutritional supplementation in one of five sampled patients (#1).

Finfings:

A review of the medical record of patient #1 was performed. The patient had an admission order for a regular diet. The "CRC (Central Receivig Center) Receiving Order" sheet indicated that the patient was able to eat all forms of protein. A nutritional screening was performed on 2/17/11, with the only thing standing out being an allergy to shellfish.

Physician orders of 2/20/11 read, "Ensure 1 can PO TID with meds supplement." A physician order of 3/01/11 read, "Can we have Ensure 1 can PO TID he wants more food." As to whether staff complied with the physician orders, no evidence was in the record.

The preceding was confirmed in an interview of the Director of Nursing on 3/29/11 at 3:53 PM.

Based on interview and a review of facility documentation, the facility failed to ensure that technical personnel in the dietary department were confirmed as being competent in their respective duties for 8 of 8 sampled employees (#1, 2, 3, 4, 5, 6, 7 & 8).

Findings:

A review of the personnel files of dietary employees #1 - #8 revealed they filled the following positions: Dietary Aide, Cook, Dishwasher and Customer Service. Evidence of competency by employees #1, #2, #3, #4, #5, #6, #7 and #8 in those positions was not found in a review of their personnel files. This was confirmed in an interview of the Director of Nursing and the Director of Ancillary Services, on 3/29/11 at 1:30 PM.