MIDDLETOWN, DE - Federal inspectors documented multiple care failures at Cadia Rehabilitation Broadmeadow that resulted in actual harm to residents, including allowing a dementia patient to become dehydrated despite medical orders for specialized assistance.
Resident Dehydration Despite Medical Orders
The most serious violation involved a dementia resident who experienced documented dehydration after staff failed to follow established hydration protocols. The resident, who had difficulty swallowing and required assistance with meals, was prescribed a specific daily fluid goal of 1500-1800 milliliters.
Medical records showed the facility's dietitian had ordered specialized adaptive equipment, including a Kennedy cup with straw, specifically designed to help the resident drink independently. However, inspectors found staff consistently failed to provide this equipment outside of meal times.
During a 14-day monitoring period, the resident fell below the minimum fluid goal on seven separate days, with intake as low as 1080 milliliters - nearly 400 milliliters below the prescribed minimum. Laboratory tests revealed a blood urea nitrogen (BUN) level of 61.0 mg/dL, significantly elevated from the normal range of 7.0-17.0 mg/dL, indicating clinical dehydration.
The elevated BUN levels are medically significant because they indicate the kidneys are concentrating urine due to insufficient fluid intake. When the body lacks adequate hydration, the kidneys retain water by producing less urine, causing waste products like urea to accumulate in the blood.
Medical Response Failures
Despite the concerning laboratory results, the nurse practitioner who reviewed the elevated BUN levels failed to address the findings with either progress notes or new medical orders. This represents a critical gap in medical oversight, as elevated BUN levels require immediate clinical attention to prevent kidney damage and other complications.
Nursing staff documented that the resident required "total dependence" for eating and drinking assistance 29 out of 39 recorded times, yet the facility failed to ensure consistent provision of the prescribed adaptive equipment or adequate staff assistance with hydration.
A licensed practical nurse told inspectors: "She gets an adaptive cup on her meal trays. But I have never seen one on her bedside tray during non-mealtimes. She usually gets her bedside water in a white styrofoam cup."
Missing Medical Visits
Inspectors also found the facility failed to ensure required physician visits for another resident with dementia and anxiety disorder. Federal regulations require nursing home residents to be seen by a physician at least every 60 days, with visits alternating between the attending physician and nurse practitioner.
The resident went 151 days without any provider visit, missing two required 60-day appointments. In a separate instance, the same resident went 231 days between physician visits, far exceeding federal requirements designed to ensure continuity of medical care.
These extended gaps in medical oversight are particularly concerning for residents with dementia, who may be unable to communicate symptoms or changes in their condition effectively.
Medication Management Deficiencies
The inspection revealed failures in pharmaceutical oversight, including unaddressed medication recommendations from the facility's consulting pharmacist. In one case, the pharmacist recommended monitoring thyroid function for a resident with elevated thyroid stimulating hormone levels, but no evidence showed the attending physician reviewed or responded to this clinical concern.
For another resident prescribed Amiodarone, a heart rhythm medication, the pharmacist recommended establishing heart rate monitoring parameters. While a nurse practitioner signed the recommendation and noted plans for cardiology referral, medical records showed no evidence that the cardiology consultation addressed this specific safety concern.
Federal regulations require facilities to have systems ensuring medication recommendations are reviewed and addressed within appropriate timeframes. The facility's own policy lacked specific deadlines for responding to pharmacist-identified irregularities.
Laboratory Services Without Orders
Inspectors documented unauthorized laboratory testing, finding that blood work was performed on a resident without a valid physician order. This violation of medical protocols raises concerns about proper authorization and oversight of diagnostic procedures.
Medical Standards and Best Practices
Proper hydration management in nursing homes requires multiple coordinated interventions. When residents have swallowing difficulties or cognitive impairments, facilities must ensure adaptive equipment is consistently available and staff provide appropriate assistance throughout the day, not just during meals.
Dehydration in elderly residents can lead to serious complications including kidney dysfunction, electrolyte imbalances, confusion, falls, and in severe cases, organ failure. Regular monitoring of fluid intake and prompt response to concerning laboratory values are essential components of quality care.
The missed physician visits represent systemic failures in care coordination. Regular medical assessments allow providers to monitor chronic conditions, adjust medications, and identify emerging health concerns before they become serious problems.
Facility Response
During the inspection exit conference, facility leadership including the nursing home administrator, director of nursing, and chief nursing officer were informed of the violations. The facility subsequently created new orders for the dehydrated resident, including instructions to offer water in the Kennedy cup every shift.
However, these corrective actions came only after inspectors identified the problems during the federal survey, raising questions about the facility's internal quality assurance systems.
Regulatory Context
These violations occurred at a 120-bed rehabilitation and skilled nursing facility that serves residents requiring both short-term rehabilitation and long-term care. The facility is required to maintain federal certification to serve Medicare and Medicaid patients.
The documented deficiencies represent failures in fundamental aspects of nursing home care: nutrition and hydration, medical oversight, and medication management. Each violation category carries specific regulatory requirements designed to protect vulnerable residents who depend on professional care providers for basic health needs.
Federal survey teams conduct these inspections annually or in response to complaints to ensure facilities meet minimum standards of care. Facilities found to have violations must submit correction plans and may face enforcement actions if problems persist.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Cadia Rehabilitation Broadmeadow from 2025-01-22 including all violations, facility responses, and corrective action plans.
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