State Findings:
Based on policy review, medical record review, observation, and interview, the facility failed to assess and monitor weights for 1 of 6 sampled residents (Resident #81) reviewed for nutrition.
The findings include: Review of the facility’s policy titled, Weight Monitoring, revised 7/11/2018, revealed .Interventions for Weight Management .If significant weight change is identified .The Registered Dietician will be notified . Residents will be weighed weekly X [times] 4 .and reviewed until the resident’s weight has stabilized .
Review of the medical record, revealed Resident #81 was admitted to the facility on [DATE] with diagnoses of Dementia, Hypertension, Anemia, Congestive Heart Failure, Rheumatoid Arthritis, and Cerebrovascular Disease.
Review of a Weight Variance Report dated 7/4/2021, revealed Resident #81 weighed 188.4 pounds.
Review of a Weight Variance Report dated 1/5/2022, revealed Resident #81 weighed 172.80 pounds. This represented an 8.28% weight loss in 6 months, a significant weight loss.
Review of the Weight Variance Reports revealed weekly weights were not obtained for Resident #81 after his significant weight loss on 1/5/2022.
During an interview on 1/26/2022 at 2:58 PM, the RD confirmed Resident #81 had a significant weight loss on 1/5/2022. The RD stated, I determined he has good intake .with assistance at meals .His current intake was meeting his nutritional needs .continue his current nutritional plan of care . The RD was asked if he recommended weekly weights for Resident #81 when he had the significant weight loss on 1/5/2022. The RD stated, .As far as weekly weights I try to prioritize, look at staff .wouldn’t want to overload the staff and especially for me coming in only 2 days a week, have to prioritize who really needs the weekly weights .
During an interview on 1/27/2022 at 8:27 AM, the Director of Nursing confirmed the RD should have identified Resident #81’s significant weight loss on 1/5/2022 and should have put weekly weights in place for Resident #81.
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