Lions Gate

The surveyor reviewed the medical record for Resident #51.

A review of the Admission Record, an admission summary, revealed the resident had diagnoses which included, vascular dementia, gastro-esophageal reflux disease (GERD) and dysphagia (difficulty swallowing).

A review of the quarterly Minimum Data Set (MDS), an assessment tool, dated 1/28/25, included the resident had a Brief Interview for Mental Status (BIMS) score of 11 out of 15, which indicated the resident's cognition was moderately impaired.

Further review of the MDS revealed the resident had a weight loss of 5% or more in the last month, or 10% or more in the last six months, while not on a physician-prescribed weight loss regimen.

A review of the individual comprehensive care plan (ICCP) included a focus area, dated 5/29/24, that the resident had nutritional problem related to dementia, anxiety, depression, diabetes, dysphagia, and mechanical altered diet.

Interventions included: 5/29/24, monitor weight as ordered.

Notify Registered Dietician (RD)/ Medical Director (M)D as needed of weight gain/loss.

A review of the Order Summary Report (OSR), dated as of 2/11/25, included the following physicians' orders:

A PO, dated 12/9/24, for carbohydrate, controlled diet.

Mechanical soft- ground meat texture, thin liquids consistency.

A PO, dated 1/27/25, for a supplement two times a day for weight loss.

A PO, dated, 1/24/25, for weekly weights times 4 weeks one time a day every Wednesday for 4 weeks.

315499

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 315499 B.

Wing 02/13/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Lions Gate 1100 Laurel Oak Road Voorhees, NJ 08043