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Based on policy and procedure review, medical record review and staff interview, the registered nurse failed to supervise and evaluate the care planned for each patient as required per facility policy and procedure related to documentation of status of appetite and/or percent of meals eaten for 5 of 5 (N1, N2, N3, N4 and N5) open and closed patient medical records reviewed.

Findings:
1. Policy No.: NSI-ACT_30 titled, "Guidelines for 24 Hour Documentation and Patient Care Documentation Record", 6/13/12 at 12:32 PM, indicated on pg. 4, under Documentation Guidelines section, bulleted points, "Real-time documentation is to be performed at the patient's bedside."

2. Review of closed patient medical records on 5/2/11 at 12:14 PM, indicated patient:
A. N1 (client named in complaint) was admitted to the facility on 3/20/12 at 3:37 PM for altered mental status. Daily Cares/Safety Flow Sheets indicated there is lack of documentation of status of appetite and/or percent of meals eaten on: 3/22/12, breakfast and lunch; 3/26/12, breakfast and lunch; 3/27/12, breakfast, lunch and dinner; 3/28/12, breakfast and dinner; 3/29/12, breakfast, lunch and dinner; 3/30/12, breakfast and lunch; 3/31/12, breakfast and dinner; 4/1/12, breakfast, lunch and dinner; 4/2/12, dinner; 4/3/12, lunch and dinner; 4/4/12, breakfast and lunch; 4/5/12, dinner; 4/6/12, breakfast; 4/7/12, breakfast, lunch and dinner; 4/8/12, breakfast, lunch and dinner; and 4/9/12, lunch and dinner.

B. N2 was currently admitted to 5 West 2 Neuro IMCU/Neuro ICU for Multiple Sclerosis exacerbation and their open medical record was reviewed on 6/13/12 at approximately 12:10 PM. Daily Cares/Safety Flow Sheets indicated there is lack of documentation of status of appetite and/or percent of meals eaten on: 6/10/12, dinner and 6/12/12, lunch.

C. N3 was currently admitted to 5 West 2 Neuro IMCU/Neuro ICU for CVA (cerebrovascular accident) and their open medical record was reviewed on 6/13/12 at approximately 12:40 PM. Daily Cares/Safety Flow Sheets indicated there is lack of documentation of status of appetite and/or percent of meals eaten on: 6/10/12, breakfast and 6/11/12, lunch.

D. N4 was currently admitted to 5 West 2 Neuro IMCU/Neuro ICU for dyspnea/syncopal episode and their open medical record was reviewed on 6/13/12 at approximately 1:10 PM. Daily Cares/Safety Flow Sheets indicated there is lack of documentation of status of appetite and/or percent of meals eaten on: 6/9/12, dinner; 6/10/12, dinner; and 6/11/12, dinner.

E. N5 was currently admitted to 5 West 2 Neuro IMCU/Neuro ICU for syncope and their open medical record was reviewed on 6/13/12 at approximately 1:40 PM. Daily Cares/Safety Flow Sheets indicated there is lack of documentation of status of appetite and/or percent of meals eaten on: 6/7/12, lunch and 6/9/12, breakfast and dinner.

3. Personnel P6 was interviewed on 6/13/12 at 11:53 AM and confirmed, the expectation for nursing staff, RN's and CNA's, is to document % of meal eaten and appetite for breakfast, lunch, and dinner. This was not being completed for every meal for closed and open patient medical records reviewed for patients N1-N5.