Eldorado Rehab & Healthcare

hypothyroidism, anorexia, gastro-esophageal reflux disease with esophagitis, osteoporosis, and dysphagia.R13's physician's order sheet dated 11/25/25 documents orders including but not limited to regular diet with mechanical soft texture, regular liquid consistency, health shake three times per day with meals.R13's most recent care plan documents a focus area for the potential for a nutritional problem dated 11/24/23.

Interventions for this focus area include but aren't limited to invite R13 to activities that promote additional intake dated 11/24/23 and provide and serve diet as ordered dated 11/24/23.

Another focus area on same care plan documents R13 had potential for impairment to skin integrity dated 11/24/23.

Interventions for this focus area include but aren't limited to encourage good nutrition and hydration to promote healthier skin dated 11/24/23.

Another focus area for R13 documents R13 has osteoporosis dated 11/24/23.

Interventions documented for this focus area include but aren't limited to encourage intake of dairy products, cereals enriched with calcium and vitamin D dated 11/24/23. R13's MDS dated [DATE] documents in section GG R13 is a set up/clean up assistance for eating.R13's dietary notes by V6, Registered Dietician dated 10/31/25 documents R13 had significant weight loss the past 2-3 months.

Weight loss has slowed down.

Current body mass index is low for age. R13 tolerates liquids better than solids. It is appropriate to add supplement with meals to provide nutrient dense liquid option for better tolerance related to pain with swallowing.On 11/24/25 at 1:00 P.M., observed R13's lunch tray not to contain the health shake on her tray. R13's meal ticket lying on her tray documents R13 was to have a health shake administered with her lunch time meal.On 11/24/25 at 2:00 P.M., V17, Dietary Aide stated he would expect residents' ordered supplements to be on the residents' trays when they leave the kitchen. V17 stated the reason R13's ordered health shake wasn't on her lunch tray was because V17 had simply forgotten to put it on the tray. On 11/24/25 at 3:16 P.M., V9, Registered Nurse stated she would expect any nutritional supplements ordered by the medical doctor to be on the tray when they go out of the kitchen. On 11/25/25 at 1:04 P.M., V5, Dietary Manager stated any ordered nutritional supplements should go out with the meal tray they are ordered to be administered with. V5 stated there is no reason they should not be included on the meal tray. V5 stated the supplements reportedly missing from R13's tray was unacceptable. V5 stated all supplements should be on the trays when they leave the kitchen. On 11/25/25 at 4:05 P.M., V1, Administrator stated she would expect the nutritional supplements to be administered as ordered to all residents. V1 agreed some of the possible adverse outcomes that could stem from residents not receiving their ordered nutritional supplements could include but not be limited to weight loss, loss of muscle mass affecting balance, strength, mobility, and prolonged or decreased ability to heal.On 11/25/25 at 2:32 P.M., V7, Medical Doctor stated she would expect the facility to administer or at least offer the nutritional supplements to R1 and R13 as they are ordered. V7 stated if nutritional supplements are not administered as ordered it could cause a decline in the affected resident's overall health, cause malnourishment if they are already prone to that, can increase the adverse effects of her chronic illnesses, affect her ability to heal, maintain weight and muscle mass.On 11/25/25 at 2:44 P.M., V6, Registered Dietician stated she would expect the facility to administer the ordered nutritional supplements as ordered by the medical doctor and recommended by her. V6 stated if nutritional supplements are not administered as ordered to the residents it could cause decrease in ability to heal, further weight loss, decrease in muscle mass, causing further weakness, and increased risk of falls.

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