CMS Manual System - Louisiana Department of Health and Hospitals

Objectives
Use
INVESTIGATIVE PROTOCOL
NUTRITIONAL STATUS
To determine if the facility has practices in place to maintain acceptable parameters
of nutritional status for each resident based on his/her comprehensive assessment.
To determine if failure to maintain acceptable parameters of nutritional status for
each resident was avoidable or unavoidable (the resident‘s clinical condition
demonstrates that maintaining acceptable parameters is not possible).
To determine if the resident has received a therapeutic diet when there is a
nutritional indication.
Use this protocol for each sampled resident to determine through interview, observation
and record review whether the facility is in compliance with the regulation, specifically:
To determine if residents maintained acceptable parameters of nutritional status,
relative to his/her comprehensive assessment;
For a resident who did not maintain acceptable parameters of nutritional status, to
determine if the facility assessed and intervened (e.g., therapeutic diet) to enable the
resident to maintain acceptable parameters of nutritional status, unless the resident‘s
clinical condition demonstrated that this was not possible; and
For a resident who is at nutritional risk, to determine if the facility has identified
and addressed risk factors for, and causes of, impaired nutritional status, or
demonstrated why they could not or should not do so.
Procedures
Briefly review the RAI, care plan, and any additional relevant nutritional assessment
information that may be available to identify facility evaluations, conclusions, and
interventions to guide subsequent observations.
NOTE: For the purposes of this investigation, conduct record reviews prior to meal
observations to note the resident‘s therapeutic diet, food texture and level of
required assistance with meals.
Observation
Observe residents during the initial tour of the facility and throughout the survey process.
To facilitate the investigation, gather appropriate information (e.g., dining style,
nourishment list, schedules, and policies).
During observations, surveyors may see non-traditional or alternate approaches to dining
services such as buffet, restaurant style or family style dining. These alternate dining