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Based on clinical record review and interview, it was determined the facility failed to ensure the patient's plan of care was updated and kept current for six (Patient #1, #2, #3, #5, #6, and #7) of 10 (Patient # 1-10) patients admitted to the facility. The failed practice had the potential to affect all patients admitted to the facility. The findings follow:

A) Patient #1 was admitted on 05/14/10. The Interdisciplinary Team Conference form dated 05/21/10 indicated the patient was at risk for falls and was incontinent. The Interdisciplinary Team Conference Form signature page did not contain a signature indicating a nurse was present for the conference. The Interdisciplinary Plan of Care was dated to be initiated on 05/14/10 according to the nurse's signature on page 25 of 25 of the Plan of Care. The Interdisciplinary Plan of Care did not show documentation of the patient being at risk for falls or that the patient was incontinent. The last date documented on the Interdisciplinary Plan of Care by the nursing personnel was on 05/14/10. The patient was discharged on 05/21/10. The findings were confirmed in an interview with the Chief Nursing Officer on 06/18/10 at 1045.
B) Patient #2 was admitted on 05/06/10. The Interdisciplinary Team Conference form signature page dated 05/10/10 did not contain a signature indicating a nurse was present for the conference. The Interdisciplinary Plan of Care was dated to be initiated on 05/06/10 according to the nurse's signature on page 25 of 25 of the Plan of Care. No other documentation was present in the clinical record indicating the patient's Interdisciplinary Plan of Care was updated during the patient's admission to the hospital. The last date documented on the Interdisciplinary Plan of Care by the nursing personnel was 05/06/10. The patient was discharged on 05/25/10. The findings were confirmed in an interview with the Chief Nursing Officer on 06/18/10 at 1100.
C) Patient #3 was admitted on 05/26/10. The Interdisciplinary Team Conference form signature page dated 06/12/10 did not contain a signature indicating a nurse was present for the conference. The Interdisciplinary Plan of Care was dated to be initiated on 05/26/10 according to the nurse's signature on page 25 of 25 of the Plan of Care. No other documentation was present in the clinical record indicating the patient's Interdisciplinary Plan of Care was updated during the patient's admission to the hospital. The last date documented on the Interdisciplinary Plan of Care by nursing personnel was 05/26/10. The patient was discharged on 06/12/10. The findings were confirmed in an interview with the Chief Nursing Officer on 06/18/10 at 1100.
D) Patient #5 was admitted on 06/07/10. The Patient Daily Flowsheet/Treatment Record indicated the following diet percentage eaten by the patient:
1) 06/08/10: 0800- 0%; 1200 - 0%; no documentation of meal % eaten for evening meal
2) 06/09/10: 0800 - 20%; 1200 - 0%; 1700 - 0%
3) 06/10/10: 0800 - 20%; 1200 - 50%; 1700 - 40%
4) 06/11/10: no documentation of breakfast or lunch meals; 1700 - 20%
5) 06/12/10: 0700 - 0%; 1200 - 10%; no documentation of evening meal
6) 06/13/10: 0700 - 10%; 1200 - 5%; 1700 - 25%
7) 06/14/10: 0700 - 10%; 1200 - 10%; 1700 - 20%
8) 06/15/10: no documentation of meals consumed
9) 06/16/10: 0700 - 10%; 1200 - 0%; 1700 - 0%
10) The Dietitian note dated 06/11/10 at 1210 stated the patient was refusing meals at times, oral intake was less than 20% of regular diet and recommended assistance with all meals. The Dietitian note dated 06/14/10 at 1250 stated patient was consuming approximately 10% of regular meals and recommended to add Ensure and assist with meals. The Dietitian note dated 06/17/10 at 0640 stated oral values remain poor and assist with meals as needed. The Nutrition/Hydration portion of the Interdisciplinary Plan of Care was dated as initiated on 06/07/10. No other documentation was present on the Nutrition/Hydration portion of the Interdisciplinary Plan of Care indicating it was updated according to the patient needs for continued poor oral intake of meals. There was no documentation present in the record the patient was assisted with meals. The findings were confirmed in an interview with the Chief Nursing Officer on 06/17/10 at 1440.
E) Patient #6 was admitted on 06/02/10. A urology consult was ordered on 06/03/10 at 0930 for retention and resistance met when placing a Foley catheter. A Foley catheter was placed and was ordered to be discontinued on 06/04/10 at 7:00 AM. The Interdisciplinary Plan of Care was not dated or signed to indicate the Plan of Care was updated for the change in the patient's condition. The findings were confirmed in an interview with the Chief Nursing Officer on 06/17/10 at 0915.
F) Patient #7 was admitted on 06/04/10. The physician orders dated 06/04/10 revealed a dysphasia diet with honey thick liquids was ordered. The physician's orders dated 06/16/10 at 0945 revealed the patient's diet was changed to Mechanical soft with thin liquids. There was no documentation present to indicate the Interdisciplinary Plan of Care was updated to reflect the change in the patient's care. The findings were confirmed in an interview with the Chief Nursing Officer on 06/17/10 at 0935.