SMQT QA – Dietary Issues

During tray line observation the surveyor observed that the ham salad sandwiches sitting on top of an unheated steam table unit next to the macaroni and cheese in a heated unit. In order to check if there were appropriate food temperatures, the surveyor would first:

When observing the dish washing procedures, a surveyor saw that the water temperature of the machine was only 120 degree Fahrenheit The surveyor need to check to see if:

Which of the following, if observed by a surveyor, would be considered a dehydration risk factor?

At a particular long term care facility, 98% of all organized resident activities are held between the hours of 11 a.m. and 6 p.m. Monday through Friday. The survey team should

During the day of the survey based on you observation, interview and record review the facility failed to protect a resident from sexual abuse resulting in serious psychosocial harm. A resident, with moderate confusion and who was dependent on staff for care, reported to staff that she was “touched down there” and identified the alleged perpetrator. However, staff, who thought the resident was confused, did not report her allegation to facility administration and failed to provide protection for the resident allowing ongoing access to the resident by the alleged perpetrator. The resident expressed recurring fear whenever the perpetrator approached the resident, exhibited crying and agitation, and declined to leave her room. What will you do at this point?

On the second day of the survey one of the facility staff talked to you about the two residents where the two staff posted several videos and photographs on social media taken during bathing, using the bathroom and grooming, which included nude photos and photos of genitalia. As a surveyor what will you do after receiving the information provided by the staff?

During facility tour, the surveyor noted a strong urine odor. Residents were observed to be in bed with soiled clothes and linens. Residents told the surveyor that they did not get out of bed or dressed since there were not enough nurse aides to assist them. During interviews with nurse aides, it was reported that the facility lacked supplies, such as incontinence briefs, laundry/housekeeping supplies, gloves and food. Which of the following action will the surveyor will you do next?

During a survey, the surveyor observed that a resident’s call light was pinned to a privacy curtain out of reach of the resident. During interview the resident stated that staff removes the call light at night because the nursing staff said he used it too much and they did not have time to answer the light all the time. The resident began crying, and expressed fear that something would happen and he would have no way of getting assistance as staff would not come if he called out for help. Which of the following initial pool process will the surveyor will conduct?

During a complaint survey, the investigation revealed that a cognitively-impaired resident had been left with his lower body uncovered and completely exposed, and unattended for several hours. Also, the investigation also identified that his catheter bag had been left lying flat on the bed so that urine could not flow freely or drain, resulting in expressions of pain and discomfort. Interview with the charge nurse revealed that she was the only nurse in the building during the night shift and stated that the she was unable to monitor the nurse aides’ provision of care because she was providing treatments on other units. It was identified that insufficient nurse staffing has been reported to the administration and that this was an ongoing concern. Which of the following based on statements reflects the non-compliance of the facility?

A resident with cognitive impairment did not want to be bathed and began yelling at a staff person and called her a derogatory name. The staff person yelled back at the resident saying, “You can’t call me that!” and called the resident the derogatory name. Another staff member in the bathing area, overheard the exchange and immediately reported the exchange to the charge nurse. The resident was reported to be upset initially, but did not exhibit any further changes in behavior and requested not to be assigned to that staff person. Which regulatory violation will the surveyor cite in the from 2567?

During a facility survey of a resident, who had a medical condition in which she had loss of hair, owned two wigs which were personalized for her needs which she used consistently during the daytime hours. The surveyor observed that the resident was “crying loudly, shouting and was hysterical” and when investigated, she stated two employees removed her wig on her head and they were talking and laughing about her appearance. What should the surveyor do at this time?

The resident with a history of suicidal ideation and displaying behavioral symptoms which included episodic periods of yelling and screaming, especially towards the end of the day and during the night. According to the resident’s record, after dinner last evening, the resident was placed by staff in her recliner with a tray attached by the nurse’s station. It was documented and corroborated by staff interviews that they heard the resident yell and scream loudly, pounding on her tray. Several residents began complaining about the noise. A nurse aide transferred the resident to a wheelchair, and placed the resident, who was at risk for suicidal ideation, in a housekeeping supply room, which was used for storage of chemicals. The nurse aide closed the door and went back to the floor. The resident began crying loudly, banging on the doors and yelling for help. Another staff person thought that she heard a resident yelling, but was busy completing tasks for another resident. Afterwards, she heard the yelling continue, found the resident, and removed the resident from the room, the resident was sweating profusely, her face was reddened, and was shaking and sobbing incoherently. Upon interview, the nurse aide who had secluded the resident stated that she did not have the time to deal with the yelling, and she had to get other residents to bed. She moved the resident to the supply room to quiet her down. At this time facility failed to assure that a resident was free from involuntary seclusion. What will be the surveyors decision on severity level and noncompliance?

During dining observation the surveyor noticed that resident was holding her neck and she could not speak and believed she was choking. The facility staff immediately perform the Heimlich maneuver and the resident was able to breath and speak. During the interview of the resident she stated that she was choked. According to the physician’s order the resident is on pureed diet. The food served written on the diet card was regular diet. The wrong texture of diet was provided which resulted in a choking incident for this resident. This placed the resident at risk for potential death or brain damage due to lack of oxygen from choking. Facility staff failed to follow a menu for a resident on a puree diet. What will the surveyor do at this time?

Based on a resident’s current comprehensive assessment, the resident’s nutritional needs changed; however facility staff did not change or updated a menu to meet the nutritional needs of this resident. During a record review the resident experienced significant weight loss. During the investigation which of the following care areas will be the focus of the surveyor?

During meal observations, a resident’s dietary intake appears inadequate and was determine in the meal intake record review. According to interdisciplinary team (IDT) notes the facility food service manager and registered dietitian made reasonable efforts to review and/or adjust the menu and the food plan to meet the nutritional, religious, cultural, and ethnic needs, and preferences of the resident. What will the surveyor do at this time?

During dining observation, the surveyor should watch for swallowing problems by monitoring the resident that exhibits the following:

During resident council meeting, 10 of 12 residents complained about the food. One
resident said she was always served last, five residents said the food was tasteless, and six residents said the hot foods were frequently cold. Which would be the most appropriate step for the surveyor to take at this time?

During the survey one of the surveyor is reviewing the record of Mrs. Jones an 83 years old resident and has a tube feeding. The surveyor should look to see if the following rationale was used by the facility in determining the need for the tube feeding:

During noon meal in the dining room the surveyor observed that 10 residents in the dining room did not like the broccoli and were not offered mashed potatoes as a substitute. Which of the following reason is appropriate rationale?

During the survey the team observed that the posted meal hours at a facility were 8 am – 12 noon – 5 pm. When questioned, the administrator said these were the hours that the residents had requested. What should the surveyor do next?