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Based on review of facility policy, review of facility contracts, medical record review, and interview, the facility failed to ensure a nutritional assessment by the Registered Dietitian was performed for two patients (#1, #5) of five patients reviewed, and failed to maintain a sanitary environment on two of two food storage carts for one of one alternate food preparation areas.

The findings included:

Review of facility policy Dietary Assessment/Screening dated 01/01/12 revealed "...(1) the nursing staff, utilizing the Pioneer Health Systems Nutritional Screening form, shall complete the top section [scoring section] of the form...if the patient scores 6 or higher, complete the remainder of the form and fax to dietician...(2) the registered dietitian will assess the patient and fax the form back to the nursing station or other designated area...recommendations are then put in place as orders in the patient's chart and carried out...(4) dietitian assessments should be done within 72 hours..."

Review of facility policy Nutritional Screening/Nutritional Assessment with no date revealed "...nursing will perform a nutritional assessment screening form on admission of a patient to medical surgical unit and if the score is 6 or greater, a nutritional consult will be ordered for a registered dietitian within 8 hours of admission...the RN [Registered Nurse] or LPN [Licensed Practical Nurse] will complete the nutritional assessment within 8 hours of an admission...the RN or LPN will then confirm a nutritional screening consult is ordered if the score is greater than 6 for the registered dietitian...(2) the registered dietitian will assess the information and complete the nutritional assessment with recommendations...recommendations from the dietitian will be called to the provider by the nurse or viewed by the provider for verbal confirmation to start the recommendation..."

Review of a Clinical Consultant Dietitian Contract dated 9/3/13 revealed, "...the consultant dietitian will provide guidance for the nutritional care of the patients and/or residents as well as outpatients when requested...this shall include but not limited to nutritional assessments, care plans, patient education, tube feedings and request from patient physicians...when the consultant is not on premises nutritional screens shall be completed via [by] fax and will be a part of the total hours provided...the consultant dietitian will be responsible for ongoing charting in the patients charts, as well as carrying out the orders through dietary by keeping the dietary manager informed..."

Medical record review revealed Patient #1 was admitted to the facility on 3/23/15 with diagnoses including Diarrhea and Vomiting.

Medical record review of the admission nursing assessment dated 3/23/15 at 12:18 PM revealed the patient scored a 10 on the nutritional assessment, indicating a nutritional consult was needed. Further review revealed no dietitian assessment had been completed for the patient.

Medical record review revealed Patient #5 was admitted to the facility on 3/26/15 with diagnoses including Pneumonia and Congestive Heart Failure (CHF). Further review revealed the patient was discharged on 3/31/15.

Medical record review of the admission nursing assessment dated 3/26/15 at 1:15 PM revealed the patient scored a 7 on the nutritional assessment, indicating a nutritional consult was needed. Further review revealed no dietitian assessment had been completed for the patient.

Telephone interview with the Dietitian on 4/1/15 at 2:15 PM revealed, "...I do have a contract with the facility to provide nutritional services...I have not done any assessments or consults lately due to a contract issue..."

Interview with the Director of Nursing on 4/1/15 at 3:40 PM, in the administrator's office, revealed "...the admission nursing assessment is done by the nurse...if the patient scores 6 or above the system flags the patient for a nutritional assessment by the dietitian...the dietitian can see the patient in the facility or do a computer assessment...[dietitian] has access to the patient's record 24 hours every day..." Continued interview confirmed the dietitian had not completed nutritional assessments for patients #1 and #5 within 72 hours of the patient's admission and the facility failed to follow the policy related to nutritional assessments.

Observation on 4/1/15 at 4:30 PM, in the food preparation room, revealed a buildup of dust on the top of two of two food storage carts stored in the food preparation room.

Interview with the Administrator on 4/1/15 at 4:30 PM, in the food preparation room, confirmed the dust buildup on two of two food storage carts in the clean alternate food preparation room.