The Banyan At Montclair

15 mg every night for dementia with depression and weight loss. A review of physician order for

orders for weekly weights and renal ultrasound due to history of mass to significant weight. A

Service Note revealed email was sent to Resident 3's POA regarding Resident 3 refusing meals, not eating, significant weight loss and sleeping a lot.

The email suggested a discussion about hospice. A review of Resident 3's Progress Notes between 10/20/25 and 1/8/26 did not reveal any documentation of Resident 3's POA being notified of Resident 3's weight changes, orders for prealbumin lab, new orders for potassium chloride, metformin, and mirtazapine. A review of Medical Professional Progress Notes dated 10/15/25, 10/27/25, 11/18/25, 11/24/25, 12/12/25, 1/5/26, and 1/8/2026 did not reveal any documentation of Resident 3's POA being notified of Resident 3's weight changes, orders for prealbumin lab, new orders for potassium chloride, metformin, and mirtazapine. In an interview on 1/29/26 at 12:55 PM, Registered Dietitian A confirmed that Registered Dietitian A had not spoken with Resident 3's family regarding Resident 3's weight loss. In an interview on 1/29/26 at 3:09 PM and 4:18 PM, ADON B [Assistant Director of Nursing] confirmed that the nurses are to notify POA of changes in condition including weight loss and changes in medication. ADON B confirmed ADON B contacted Resident 3's POA about weight loss and kidney ultrasound on 1/8/26 and family declined. ADON B confirmed that no additional information could be located regarding notification of Resident 3's POA.

285054 01/29/2026

The Banyan at Montclair 2525 South 135th Avenue Omaha, NE 68144