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MEDICAL CITY PLANO 3901 W 15TH ST PLANO, TX 75075 Jan. 31, 2018
Based on record review and interview, the facility failed to document evidence that the patient had food consumption during the admission timeframe to show the patient nutritional needs met, in that, Patient #6's medical record did not document food consumption for the admission.

Findings included

Patient #6's medical record did not document evidence that the patient received any meal or food for the time in the ER, Observation/Admit Holding area, or during the admission on the floor.

The dietary department record reflected the patient ordered meals. It did not document the patient received them or had any consumption during the admission.

During an interview on 1/31/18 ending at 4:12 PM, Personnel #8 was informed meal consumption was not documented in the record, asked about the current practice, if meal consumption is documented. Personnel #8 stated, "No. We don't document meals received by the patient or consumption."