HospitalInspections.org

Based on an interview with staff, the facility failed to meet the Food & Dietetic Services Condition of Participation as evidenced by:

* A0621 - The facility did not have a dietetian and had been without one since August 2018.

Based on an interview with staff, the facility did not have a qualified dietitian, full-time, part-time, or on a consultant basis.

Findings were:

Patient #1 was admitted to the facility on 4-2-19 with a medical history that included diabetes mellitus type II.

During patient #1's nursing admission assessment, a nutritional screen for high risk factors was performed. The screening stated "Score of 10 or above requires consult". Patient #1 scored 15 due to her diabetes mellitus and chewing difficulties resulting from missing teeth, tooth decay and a denture. "Dietary Needs/Current Diet" stated "soft diet". A "diet review" was completed by the facility's dietary manager on 4-3-19 and stated that a dietary consult by a registered dietitian was needed. No such consult (or a physician's order for the necessary consult) was found in the clinical record for patient #1. An admission dietary order stated "DM [diabetes mellitus] diet, low salt, low fat", but the dietary texture was not addressed until 4-15-19, when an order was written that stated "please change pt's [patient's] diet to mechanical soft diet/snacks due to 0 [no] teeth".

When asked if the facility had a dietitian, staff #4 stated that they did not and had been without a dietitian since 8-17-18.

Facility policy AS-05 titled "Nutritional Screening" states, in part:
"Purpose:
To establish guidelines and criteria for assessing patients' nutritional risk for identifying characteristics commonly associated with nutritional problems and who may require a comprehensive nutritional assessment. Screening allows for proper intervention by physician and registered dietitian.
Policy:
Patients are screened for the need of nutritional intervention as a component of the Initial Nursing Assessment process performed by the admitting nurse.
Procedure:
Nurse:
* 1. Complete nutritional screening which is a component of the initial nursing assessment.
* 2. If the nutritional screening triggers the need for a Registered Dietitian consult, the nurse will notify the physician and obtain order."

The above was confirmed in an interview with the CEO and other administrative staff on the evening of 7-24-19.