HospitalInspections.org

Based on review of hospital policy and procedure, hospital documents, observation on tour, review of personnel files, patient interviews, and staff interviews, it was determined the hospital did not ensure adequate nutritional needs for the patients. (#'s 2 and 3).

Findings include:

Review of hospital policy Nurtritional Assessment revealed: "...a qualified Dietician will supervise the nutritional aspects of patient care in order to ensure patients receive appropriate nutritional balances and nutritional needs...."

Review of hospital documents provided by the Chief Clinical Director revealed a handwritten outline titled, "Recommend" "...menu standardized 3 days 3 meals, then nutrient analysis can be completed: #kcal (kilocalorie), pr (protein),CHO(carbohydrate), fat, etc meeting (recommended dietary allowance) RDA's, standardized purchasing list item by item, diet manual (by diet), way to puree meals (baby food, hot cereal, cream soups), food inventory before and after all meals for usage and purchasing...log of temps of refrig (refrigerator), freezer and meals served...daily log of # (number) of diets and food items served and start/end times by meals...cleaning of equipment schedule...daily inventory before breakfast...breakfast selection...hot/cold cereal with milk; pancakes, waffles, french toast with sugar free syrup/regular and margarine, fruit/juice (fresh banana, orange, applesauce, fruit cup), milk 2% skim, egg entree...turkey sausage link or patty...turkey bacon...egg substitute (will need to be cooked )...coffee, tea...cardiac...low fat, low sodium (600 gm)/meal, low chol less than 70 gram/meal...DM (diabetes mellitus) low CHO (carbohydrates), low sugar, low fat, low Kcal (kilocalories) (600/meal)...Insulin Dm (diabetes mellitus) no sugar, low CHO, no fruit justice, cheerios, cornflakes, bran flakes, rice krispies, hot cereal ??...renal rice and noodles, no tomato, no potatoes, no bananas, no orange...2000 Kcal total fat 65 gm (grams), chol (cholesteral) less than 300, Na (sodium) 2400, K (potassium 3500, total CHO (carbohydrate 300...."

Observation on tour of the kitchen revealed the presence of a dietary manual, a freezer containing commercial frozen prepackaged dinners available in grocery stores, commercial prepackaged frozen waffles, two refrigerators with individual containers of jello, pudding, juices, and milk. Direct observation of the food supplied routinely did not identify designated meals for therapeutic purposes.

The Chief Clinical Director confirmed the meals are heated in the microwave in the kitchen area and served on disposable styrofoam containers. Eating utensils are plastic disposable, and drinking cups are styrofoam and disposable. No menu plans were observed or provided.

Review of personnel files for employee #'s 4 and 5 revealed current food handler cards and experience with food handling. There was no documentation provided the food handlers had experience with food preparation.

Patient # 2 confirmed in an interview 2/4/14, the dietician had not seen the patient since admission on 2/2/14. The patient was not taking oral nutrition at the time of the interview and could only tolerate ice chips.

Patient # 3 confirmed in an interview 2/4/14, some of the food did not taste very good; and did not know if a dietician was involved in the dietary care.

The Chief Clinical Director confirmed in an interview on 2/4/14, patient # 3 was admitted on 1/31/14, and received a nutritional assessment by the RN on admission.

The Chief Nursing Officer and the Chief Clinical Director confirmed in an interview on 2/4/14, the hospital uses the dietician as a consultant when a therapeutic diet is ordered by the practitioner and a nutritional assessment is required. As of 1/27/14, all meals and kitchen supplies are purchased by the hospital, and food preparation occurs in the hospital kitchen.

The dietician did not return phone calls to the hospital at the time of the survey.

No documentation of contractual agreement with a dietician was provided to the surveyor at the time of the survey.