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Based on clinical record review, review of Braden Score - Nutrition, review of Adult Assessment and interview it was determined staff failed to update Braden scores to reflect low meal consumption percentages and failed to include low meal consumption in the Plan of Care for three (#1, #3 and #4) of ten (#1-#10) patients. Failure to update Braden scores and the Plan of Care to reflect low meal consumption percentages, did not assure the Dietitian was made aware of potential nutritional deficits. The failed practice was likely to affect all patients admitted to the Facility. Findings follow:

A. Review of Braden Scoring, Nutrition, provided by the Director of Medical/Surgical Services on 11/12/14 at 1150 revealed a score of "1" was defined as Very Poor - never eats a complete meal; "2" was defined as Probably Inadequate - rarely eats a complete meal and generally eats only about ? (half) of any food offered; "3" was defined as Adequate - eats over half of most meals; and "4" was defined as Excellent - eats most of every meal.

B. Review of Intake and Output and Adult Assessment for Patient #1 revealed the following:
1) On 07/17/14 at 1800, percent of meal eaten was 50, Braden Nutrition score was 3;
2) On 07/18/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3;
3) On 07/18/14 at 1300, percent of meal eaten was 25, Braden Nutrition score was 3;
4) On 07/18/14 at 1800, percent of meal eaten was 25, Braden Nutrition score was 3;
5) On 07/19/14 at 0930, percent of meal eaten was 25, Braden Nutrition score was 3;
6) On 07/19/14 at 1209, percent of meal eaten was 50, Braden Nutrition score was 3;
7) On 07/19/14 at 1751, percent of meal eaten was 25, Braden Nutrition score was 3;
8) On 07/20/14 at 1300, percent of meal eaten was 0, Braden Nutrition score was 3;
9) On 07/20/14 at 1742, percent of meal eaten was 0, Braden Nutrition score was 3;
10) On 07/21/14 at 0800, percent of meal eaten was 50, Braden Nutrition score was 3;
11) On 07/21/14 at 1258, percent of meal eaten was 25, Braden Nutrition score was 3;
12) On 07/21/14 at 1800, percent of meal eaten was 50, Braden Nutrition score was 3;
13) On 07/22/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3; and
14) On 07/22/14 at 1300, percent of meal eaten was 25, Braden Nutrition score was 3.

C. Review of the clinical record for Patient #1 revealed no evidence low percentages of meal consumption was included in the Plan of Care.

D. Review of Intake and Output and Adult Assessment for Patient #3 revealed the following:
1) On 07/18/14 at 0800, percent of meal eaten was 50, Braden Nutrition score was 3;
2) On 07/18/14 at 1300, percent of meal eaten was 25, Braden Nutrition score was 3;
3) On 07/18/14 at 1800, percent of meal eaten was 50, Braden Nutrition score was 3;
4) On 07/19/14 at 1800, percent of meal eaten was 25, Braden Nutrition score was 3;
5) On 07/20/14 at 1800, percent of meal eaten was 50, Braden Nutrition score was 3;
6) On 07/21/14 at 0800, percent of meal eaten was 75, Braden Nutrition score was 3;
7) On 07/21/14 at 1300, percent of meal eaten was 75, Braden Nutrition score was 3;
8) On 07/21/14 at 1800, percent of meal eaten was 50, Braden Nutrition score was 3;
9) On 07/22/14 at 0800, percent of meal eaten was 75, Braden Nutrition score was 3;
10) On 07/22/14 at 1300, percent of meal eaten was 75, Braden Nutrition score was 3;
11) On 07/22/14 at 1800, percent of meal eaten was 75, Braden Nutrition score was 3;
12) On 07/23/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3;
13) On 07/23/14 at 1300, percent of meal eaten was 25, Braden Nutrition score was 3;
14) On 07/23/14 at 1800, percent of meal eaten was 75, Braden Nutrition score was 3;
15) On 07/24/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3;
16) On 07/24/14 at 1300, percent of meal eaten was 75, Braden Nutrition score was 3;
17) On 07/24/14 at 1800, percent of meal eaten was 25, Braden Nutrition score was 3; and
18) On 07/25/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3.

E. Review of the clinical record for Patient #3 revealed no evidence low percentages of meal consumption was included in the Plan of Care.

F. Review of Intake and Output and Adult Assessment for Patient #4 revealed the following:
1) On 07/13/14 at 1800, percent of meal eaten was 75, Braden Nutrition score was 3;
2) On 07/14/14 at 0746, percent of meal eaten was 75, Braden Nutrition score was 3;
3) On 07/14/14 at 1247, percent of meal eaten was 75, Braden Nutrition score was 3;
4) On 07/14/14 at 1800, percent of meal eaten was 25, Braden Nutrition score was 3;
5) On 07/15/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3;
6) On 07/15/14 at 1228, percent of meal eaten was 25, Braden Nutrition score was 3;
7) On 07/15/14 at 1800, percent of meal eaten was 50, Braden Nutrition score was 3;
8) On 07/16/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3;
9) On 07/16/14 at 1300, percent of meal eaten was 50, Braden Nutrition score was 3;
10) On 07/16/14 at 1800, percent of meal eaten was 25, Braden Nutrition score was 3;
11) On 07/17/14 at 0800, percent of meal eaten was 25, Braden Nutrition score was 3;
12) On 07/17/14 at 1300, percent of meal eaten was 25, Braden Nutrition score was 3;
13) On 07/17/14 at 1800, percent of meal eaten was 75, Braden Nutrition score was 3; and
14) On 07/18/14 at 0700, percent of meal eaten was 75, Braden Nutrition score was 3.

G. Review of the clinical record for Patient #4 revealed no evidence low percentages of meal consumption was included in the Plan of Care.

H. During interview with the Director of Nursing on 11/04/14 at 0850, she stated low Braden scores would trigger a Best Practice Advisory alert and would be acted upon.

I. Documented patient's meal percentages and Braden scores were verified with the Director of Nursing during clinical record review on 11/04/14 at 1040.

Based on review of policies and procedures, review of clinical records and interview, it was determined the Facility failed to follow their policy to place patients with open, draining wounds in a private room for one (#2) of ten ( #1-#10) patients. Failure to assure patients with open, draining wounds were not placed in a room with another patient did not prevent the spread of contamination/infection to the other patient. The failed practice was likely to affect all patients admitted to the Facility. Findings follow:

A. Review of policy, "Infectious Disease Precautions" revealed Patient Placement: a private room should be made available for all patients with an open draining wound...

B. Review of the clinical record for Patient #1 revealed she was admitted to the Facility on 07/17/14 and placed in Room 213 until discharged on 07/23/14.

C. Review of the clinical record for Patient #2 revealed she was admitted on 07/09/14 was discharged 07/29/14 and was assigned to Room 213. Review of Progress Notes dated 07/20/14 at 0940 for Patient #2 revealed, "...now presents with abscess with the production of frank pus today". Review of Isolation - All Orders dated 07/23/14 at 1334 for Patient #2 revealed contact isolation was ordered for MRSA, left breast.

D. During clinical record review on 11/04/14 at 0950 with the Director of Nursing, it was confirmed Patient #1 and Patient #2 were in the same room at the time Patient #2's open wound was discovered on 07/20/14 until Patient #1 was discharged on 07/23/14.

Based on observation and interview it was determined the Facility failed to develop a policy to assure patient water jugs were cleaned in three (#203, #213 and #219) of three patient rooms. Failure to assure water jugs were cleaned did not prevent contamination and was likely to affect all patients admitted to the Facility. Findings follow:

A. During tour of the 2nd Floor Nursing Unit on 11/03/14 at 1015 with the 2nd Floor Nursing Supervisor, water jugs were observed in three (#203, #213 and #219) of three occupied patient rooms.

B. On interview with the 2nd Floor Nursing Supervisor on 11/03/14 at 1310, when asked how patient water jugs were cleaned, she explained staff would wipe them down when visibly soiled. When asked if there was a schedule for cleaning the jugs, she answered no.

C. On interview with the Director of Nursing on 11/03/14 at 1445, when asked what the average length of stay was for patients admitted to the Facility, she answered 12 days.