Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 531310 (X3) Date Survey Completed 05/03/2012
Name of Provider or Supplier Powell Valley Hospital Street Address, City, State 777 Avenue H, Powell, WY
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
C0279 PATIENT CARE POLICIES
CFR(s): 485.635(a)(3)(vii)

[The policies include the following:] If the CAH furnishes inpatient services, procedures that ensure that the nutritional needs of inpatients are met in accordance with recognized dietary practices and the orders of the practitioner responsible for the care of the patients, and that the requirement of ยง485.25(i) is met with respect to inpatients receiving posthospital SNF care.


This STANDARD is not met as evidenced by:
Based on medical record review and staff interview, the facility failed to provide a nutritional consult, as ordered, for 1 of 3 sample obstetrical patients (#16). The findings were: According to orders dated 4/18/12 at 7:38 PM, the registered dietitian was to complete a nutritional consult for patient #16. The order was documented as received by the dietitian on 4/19/12 (a Thursday) at 12 PM. Review of the medical record showed no evidence the consult was completed. After reviewing the record on 5/3/12 at 1:10 PM, RN #3 confirmed a nutritional consult was not provided. She further stated there was a routine order for a nutritional consult for all new mothers, but acknowledged it was not always done, especially if the patient was discharged over the weekend.