| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 531311 | (X3) Date Survey Completed 04/28/2022 |
| Name of Provider or Supplier Crook County Hospital | Street Address, City, State 713 Oak Street, Sundance, 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) |
| C1626 | NUTRITION Nutrition (§483.25(g)(1) and (g)(2) of this chapter). " §483.25(g) Assisted nutrition and hydration. (Includes naso-gastric and gastrostomy tubes, both percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy, and enteral fluids). Based on a resident's comprehensive assessment, the facility must ensure that a resident- (1) Maintains acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise; (2) Is offered sufficient fluid intake to maintain proper hydration and health. This STANDARD is not met as evidenced by: Based on review of patient records, policy review, and staff interview, the facility failed to ensure a registered dietitian (RD) was utilized by the facility to provide dietetic services and assess nutritional needs of the patients. The census was 5. The findings were: 1. Interview with the dietary supervisor on 4/26/22 at 2 PM revealed there was not currently an RD available for the facility. She stated she was in the process of completing a course to become a certified dietary manager and had an expected graduation date of January 2023. When asked about the department policies and the diet manual, the dietary supervisor was not familiar or aware of how these items were updated or reviewed. Review of the menus showed there were planned diets including Diabetic, Cardiac, 2 gram sodium (low sodium), finger foods and mechanically altered diets. The following concerns were identified: a. Interview with the DNS on 4/27/22 at 4:10 PM verified there was not any documentation to show a nutritional screen or assessment was completed for the current Swing Bed patients (#1, #2, #3, #5, #6). Further she confirmed there was not an RD available, however, there was a plan for a new graduate to start in June 2022. Additionally, the facility was working on contracting with an RD from another state who was in the process of seeking Wyoming licensure. The DNS was unaware of how long it would be for this contract to be in place. b. Review of the 4/22/22 physician history and physical for patient #5 showed the plan to address the diagnoses of Type 2 diabetes, hyperlipidemia, and essential hypertension included an order for an 1800 -calorie ADA (American Diabetes Association) diet, 2 gram sodium diet. c. Review of the 4/20/22 physician admission orders showed patient #3 had orders for a "Cardiac Diet." 2. Review of the Dietary department policies and the Acute Care/Swing Bed policies showed the following concerns: a. There was no policy or procedure on how nutritional assessments would be completed. In addition, there was nothing in place to identify the need for an RD to be utilized as the diet/nutrition professional. b. Review of the policies in the electronic program showed the only current policy was for the "Diet/Nutrition Care Manual" this was dated as last approved March 2022. However, review of this policy showed it was not specific to which manual was to be utilized, and did not address the need for approval by the medical staff who ordered therapeutic diets. c. The remainder of the dietary policies in the system had review dates of 2018 and 2019. |