HospitalInspections.org

Based on interview and record review, the facility failed to ensure compentencies were performed for 1 (Staff AA) of 2 Registered Nurses (RN) reviewed for competencies, resulting in the potential for less than optimal patient outcomes.
Findings include:

On 2/4/19 at approximately 1600 a review of the personnel file for Staff AA was conducted with the Director of Quality and Risk Manangement Staff E. Staff E explained Staff AA was the wound care treatment nurse who initially assessed patient #1 following his admission to the facility on 11/28/18. At that time, Staff E said Staff AA was on a leave of absence and not available for interview. Staff E said the wound care nurse's were not required to be wound care certified. Staff E said the

A review of the personnel file for Staff AA revealed the following:
Staff was AA hired on 2/6/18 for a position as a RN. There were no compentencies for wound care in the personnel file provided for Staff AA. Staff E said that she would check further for the documentation.

On 2/4/19 at 1630 Staff E presented the surveyor with a form for Staff AA that was titled "Wound Care Coordinator" competency dated 2/4/2019 (date of the survey investigation).
Staff E was asked to explain how Staff AA's "Wound Care" competency for Staff AA be dated 2/4/19. Staff E stated, "Oh. She's not really a wound care nurse she was just helping."

On 2/6/18 at 1300 in interview was conducted with the Chief Nurse Officer Staff A regarding the concerns. No further explanation was provided at that time.

Based on interview and record review, the facility failed to provide a diabetic diet menu for one (#1) of 4 patients reviewed for nutritional needs out of a total of 14 sampled patients, resulting in the potential for unmet nutritional care needs for patient #1. Findings include:

An interview and record review of patient's #1's closed medical record was conducted with Registered Dietician Staff F on 2/5/19 at 1310 and the following was revealed:

Staff F explained she recalled the patient and his family. She said she'd met with the patient and his family on more than occasion during his hospitalization. Physician's orders dated 12/11/18 revealed the patient was on a 2000 calorie American Diabetes Association (ADA) diet. Staff F said a carbohydrate-controlled diet was the equivalent of an ADA diet. She said the patient was allowed five servings of carbohydrate food servings per meal (breakfast, lunch and dinner). Staff F said she verbally informed the patient and his family food daily food allowances. She said there were no "Diabetic Diet menu's".

Staff F explained the nutritional services were contracted and provided by the "Host" facility. She said patients were able to order their meals on demand.
Staff F provided the surveyor copies of three menu's that were offered to patients for regular consistency diets. Staff F said patient #1 was provided a "Heart Healthy/Regular" menu. She said the patient was expected to choose from the items that were listed on the menu.

Further review of the menu revealed there were no sugar free food options listed on the menu except for sugar free jelly, sugar free syrup and sweeteners. Staff F said she did not know if the "Host" facility offered any other sugar free food options.

A tour of the "Host" facility kitchen was conducted with Staff G while accompanied by Staff F on 2/5/19 at 1400 and the following sugar free items were observed:
pudding, gelatin, lemon creme cookies and hot chocolate. When asked to explain why the "Health Heart/Regular" menu did not include the additional sugar free food options. Staff G explained that she did not know. Staff G also said the facility did not have or stock sugar free cakes, pies or ice cream. She said sometimes we have popsicles.

On 2/6/19 at approximately 1250 an interview was conducted with the Director of Nursing (DON), the Chief Nursing Officer and Staff F. The DON confirmed she was aware of the patient's concerns regarding food options. She said had referred the RD to address the patient/family concerns.