Surveys: Dietary Regulations
Posted by Patti on January 25th, 2005 / Print This Post
Survey Date: 9/15/2004
Regulation Number:0369, level D scope/severity
Regulation Title: DIETARY SERVICES
Regulation Description: The facility must provide special eating equipment and utensils for residents who need them.
Surveyor Findings:
Based on observation, record review and staff interviews, the facility failed to ensure two (#5, #13) out of 16 sample residents received the necessary adaptive equipment and utensils during their meals. Specifically, the facility failed to provide resident #5 with plastic utensils during all meals. This failure increased the risk of injury to this resident as described as a safety issue in the medical chart. The facility failed to provide a built up spoon, scoop bowl and ensure proper alignment of the plate guard for resident #13. This failure increased the risk of resident decline with self feeding. The findings included:
1. Non-interviewable sample resident #5 was admitted to the facility on 12/23/00 with the diagnoses of organic brain syndrome, cystic fibrosis, osteoarthritis, diabetes mellitus 2, and depressive disorder. The Minimum Data Set (MDS) reflected the resident’s cognitive skills for daily decision-making as severely impaired. Also, the MDS reflected the resident had periods of restlessness, fidgeting, and repetitive physical movements. The mental function varied throughout the course of the day with behaviors. The behavioral symptoms included physical abuse, resists care and wanders.
Sample resident #5 was observed in the dining room from 9/13/04 through 9/15/04:
–On 9/13/04 at 12:30 p.m., the resident was observed eating her meal with a regular silverware fork. The staff provided occasional verbal and physical cues to assist the resident with handling the fork during food intake.
–On 9/14/04 at 8:21 a.m., the resident was given her silverware (fork, knife and spoon) to use during breakfast by the staff.
–On 9/14/04 at 12:25 p.m., the resident was served her meal. The staff unfolded the napkin surrounding the regular utensils and placed the silverware by the residents’ plate of food.
–On 9/15/04 at 8:38 a.m., the resident was observed eating her breakfast meal. The regular silverware was positioned beside the meal plate.
A diet slip accompanied the plate of food for sample resident #5:
–On 9/14/04 at 8:23 a.m., the diet card revealed, “Plastic silverware with meals.”
The care plan, dietary notes and medication administration record (MAR) were reviewed on 9/14/04:
–The care plan dated 8/10/02 stated, “has a safety issue with regular silverware.” The care plan approach stated to have plastic silverware with meals.
–The dietary progress note dated 7/2/04 stated, “Resident uses plastic silverware for safety reasons.”
–The MAR for June, July and August of 2004 reflected, “plastic silverware for resident and resident at same table daily.”
On 9/15/04 at 1:00 p.m., the Rehabilitation Director and Administrator were interviewed about the use of regular silverware for resident #5, instead of plastic silverware as ordered on the MAR and diet slip:
“I don’t know why she’s supposed to have that.” “I think the plastic might break.” “The plastic fork is sharper.”
Surveyor Findings:
2. Non-interviewable sample resident #13 was admitted to the facility on 8/19/97 and had diagnoses that included Huntington’s chorea. Review of the computerized physician’s orders indicated the resident was to receive a plate guard for increased independence in eating.
Review of the care plan dated 8/18/04 indicated, “Chop meats, long noodles etc to make easier to eat. Set up meals. Adaptive silverware. Needs a large adaptive tablespoon for eating. Uses plate guard.” The care plan indicated the resident had some difficulty with feeding himself.
The resident was observed on 9/14/04 at 8:45 a.m., seated in a wheelchair in the dining room. The resident was served his meal. The CNA positioned the metal plate guard to the right of the plate. The resident had scrambled eggs at nine o’clock on his plate. The resident had regular silverware. The resident was using the spoon and using his right hand to eat. The resident was scooping the eggs to the left, off of the plate, onto the table and floor. With every bite the resident attempted to take the eggs fell onto the table or onto the floor.
The resident was observed on 9/15/04 at 8:45 a.m., seated in a wheelchair in the dining room. The resident was served his meal. The CNA positioned the metal plate guard at the top of the plate. The resident was served a built-up, curved fork and regular knife and spoon. The resident had a regular bowl with fruit loops. The resident’s eggs were along the left side of the plate. The resident’s hash browns were at four o’clock. The resident’s cut up sausage was at the top of the plate. At 8:49 a.m., the resident’s metal plate guard snapped off the plate and was resting on top of the resident’s food. The resident picked up the plate guard and put it on the table. At 8:51 a.m., the resident used his spoon and tried to scoop up a piece of egg towards the left. The egg fell onto table. The resident tried to use his left hand to push the piece of egg onto the spoon but the egg then fell onto the floor. With every bite the resident attempted to take, the food fell onto the table or onto the floor.
On 9/15/04 at 8:58 a.m., the resident started to eat his fruit loops out of the regular bowl. Every time the resident placed the regular spoon into the bowl, he would scoop the fruit loops up and towards the left. Half of the resident’s fruit loops fell onto the table.
During an interview with the rehab manager on 9/15/04 at 10:45 a.m., she stated the facility had plenty of adaptive equipment in house. The rehab manager stated the resident probably popped of the metal plate guard because of his ataxia. The rehab manager stated they could give the resident a scoop plate and bowl.