Deer Meadows Rehabilitation Center (January 8th)

Investigation determined that the nursing home failed to follow physician’s orders. Findings included the following: Review of Resident R90’s minimum data set, dated November 2, 2013, revealed that the resident was alert and oriented without any impairment of cognition. Specifically, the physician ordered that the resident was to receive up to 800 cc. of fluid on the 7:00 a.m.-3:00 p.m. shift and 800 cc of fluid on the 3:00 p.m.-11:00 p.m. shift with the remaining 200 cc of fluid available for the 11:00 p.m.-7:00 a.m. shift. There was no further delineation in the orders to indicate the amount of fluid the dietary department would provide or the amount of fluid the nursing department would provide. Review of the nursing home’ policy/procedure, entitled Intake and Output, last reviewed February 24, 2013, revealed that the purpose of the policy was to provide the methodology to record a resident’s intake and output for the purpose of observing fluid balance and stated that among the population that was served by this policy/procedure was any resident on Fluid restriction.

The policy further stated that the registered dietician would evaluate the fluid restriction and ensure fluids are ordered to accommodate meal consumption, medication administration and free fluid needs. Observations of the resident’s single room on January 2, 2014, at 10:00 a.m., revealed the presence of a 16 ounce cup, labeled with the room number, containing water on the overbed table and two 12 ounce cups, partially filled also the overbed table. The resident was present in the room and identified the cups as belonging to her. A second observation of the resident’s room on January 6, 2014, at 11:15 a.m., revealed the presence of a labeled 16 ounce cup filled with water on the overbed table. In an interview with Resident R90 at the time revealed that the resident was aware of being on fluid restriction but stated that no one told her the amount she could or could not consume. In an interview with Employee E5, a registered nurse, on January 6, 2014 at 11:25 a.m., revealed that nursing staff was unsure of the amount of fluid that was provided to the resident by nursing or by the dietary staff. Review of clinical record and the care plan at the time found new evidence of a further breakdown of the fluid restriction. In an interview with Employee E8, a registered dietician, on January 6, 2014 at 11:25 a.m., revealed that the dietician prepared a dietary card for the resident’s tray, which indicated 480 cc of fluid each breakfast and at lunch for a total of 960 cc of fluid on the 7:00 a.m.-3:00 p.m. shift. Further review of the dietary card revealed that the resident received 420 cc fluid therefore assigned to nursing for a 24-hour period.