**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide nutritional interventions in a timely manner, failed to assist during dining, failed to ensure the accuracy of the scales, and failed to identify a significant weight loss for 2 of 4 sampled residents reviewed for nutrition (Resident #111 and Resident #143). The findings included: A review of the facility's policy titled Weight Management, dated October 2021, showed the following: the nutrition reassessment and modification to the existing plan of care may be indicated. The dietitian will reassess the nutritional needs and intake of the Resident with weight change. Appropriate recommendations will be documented in the medical record and via the dietitian recommendation form. The dietitian will track resident weights monthly to ensure that all significant weight changes are recognized. A review of the facility's policy titled Weight Management, dated October 2021, showed the following: Weights are completed on admission and readmission, then weekly for four weeks, then monthly unless the physician orders is to reweigh more frequently. The Director of Nursing and Dietitian are to review the monthly and readmission weights and identify any resident requiring reweighing. Weight Loss: All residents with weight loss of 5% in 30 days, 7.5% in 3 months, and 10% in 6 months require physician notification and resident/resident representative notification. Speech and Occupational Therapy are notified as needed. Documentation of notification(s) is documented in the progress note; the care plan and [NAME] are updated with interventions. 1) A record review showed that Resident #111 was admitted to the facility on [DATE] with diagnoses of Protein-calorie-malnutrition, Muscle weakness, and Unspecific falls. A review of the Order Summary Report showed the following: Regular diet with fortified foods dated 10/04/23, and Med Pass three times a day for nutritional supplement dated 10/04/23. The Minimum Data Set assessment dated [DATE] showed a Brief Interview of Mental Status (BIMS) score of 07, which indicated moderate to severe cognitive impairment. Section B of the MDS, under vision, showed severe impairment. Under section GG, for eating, it revealed that Resident #111 needs set up or clean up assistance only. In an observation conducted on 11/06/23 at 8:45 AM, the meal carts arrived at Unit C. Resident #111 received his breakfast tray that was placed on the side table at 8:48 AM. Resident #111 was noted asleep at that time. At 9:00 AM, the Resident was still asleep and the meal tray was untouched. At 9:10 AM, the meal was still untouched at the beside. Continued observation at 9:20 AM, which was 32 minutes later, still showed that Resident #111 was asleep with the meal tray 100% untouched. In an observation conducted on 11/06/23 at 12:50 PM, the meal cart arrived at the C Unit. At 1:10 PM, the lunch tray was brought into Resident #111's room by the staff, who started assisting Resident #111 with his lunch tray. Continued observation showed staff leaving the room [ROOM NUMBER] minutes later with the lunch tray 25% consumed. A review of the amount eaten on 11/06/23 documented by staff that Resident #111 ate 76% to 100% of his meals for breakfast and lunch, which was different from what was observed by the Surveyor. In an observation conducted on 11/07/23 at 8:50 AM, Resident #111 was in his room with Staff F, Certified Nursing Assistant (CNA), assisting the Resident with his breakfast meal. Resident #111 ate about 75% of his meal. In this observation, Staff F stated that Resident #111 needs assistance with his meals. In an observation conducted on 11/07/23 at 1:03 PM, Resident #111 was noted in his room with the lunch tray and no assistance from staff in the room. In this observation, Resident #111 was asked if he needed assistance with his meals and was not able to answer the Surveyor. Continued observation showed Staff F coming into the room to aid Resident #111 with his meal at 1:21 PM, which was 17 minutes later. She left the room with Resident #111's lunch tray 9 minutes later. In an observation conducted on 11/08/23 at 8:28 AM, Resident #111 was in his room eating the breakfast meal on his own. Staff B, the Licensed Practical Nurse, entered the room at 8:33 AM and sat near Resident #111, assisting him with the breakfast meal. Staff B was observed leaving the room at 8:52 AM, and the tray was observed to be 100% consumed. In this observation, she was asked by the Surveyor if Resident #111 needed assistance with his meals, and she said, he only needs cueuing. The Nutrition Evaluation Comprehensive dated 10/03/23 revealed the following: Resident #111's admission weight was 116.2 pounds with an Ideal Body Weight of 166 pounds, and his Body Mass Index (BMI) was noted at 16.7, which is underweight. It further showed that Resident #111 reported good appetite with 75 percent to 100 percent intake of meals. It further revealed that Resident #111 had inadequate oral intake, as evidenced by his BMI and signs of muscle wasting. Reviewing the Weights and Vitals Summary showed that only one weight was taken for Resident #111 on 10/04/23, and no other weights were recorded. The care plan initiated on 10/04/23 revealed the following: Resident #111 has a nutritional problem or potential nutritional problem related to Malnutrition, Low BMI, and nutritional supplements in place. To maintain weight, maintain nutritional intake, and monitor meal consumption, amount assistance needed with meals, and tolerance to diet/fluids. A progress therapy referral dated 10/03/23 revealed that Resident #111 has difficulty feeding self and is blind. He also needs assistance with eating, dressing, and toileting. In an observation conducted on 11/08/23 at 10:04 AM, the Surveyor requested that Resident #111's weight be taken. Resident #111 was taken by Staff E, Registered Dietitian, from Unit C to Unit A to be placed on the stationary scale. Staff E reported that the two Hoyer Lift scales that they have in the facility, are not working and they only have one stationary scale that is working on Unit A. Continued observation showed that Resident #111's weight was 106 pounds. This showed a weight loss from 116.2 pounds to 106 pounds, which was a significant weight loss of 9.8% in about one month. In an interview conducted on 11/08/23 at 10:00 AM, Staff B, Licensed Practical Nurse, stated that weights are usually decided between nursing and dietary and are taken right away after admission or the next day. When asked about the weight policy of the facility, she said, Let me check. She looked it up and reported that weights need to be taken on admission and every week after admission for one month. When asked who records the weight in the system, she said that it is done through communication between nursing and the dietary, and she thinks that the list is given to the Dietitians. She then said, If there is a specific form for the weights, I do not know. In an interview conducted on 11/08/23 at 12:20 PM with Staff E, Registered Dietitian, he was asked why Resident #111 did not have weekly weights since his admission on [DATE]. He stated, Looks like nursing did not do it. Staff E said that Resident #111 had a high nutritional risk since his BMI was very low. When asked by the Surveyor why Resident #111 has not been followed since his admission, he said that nursing did not report any poor intake of meals or any weight loss. Staff E then said I had been following up on his weekly weights, but they needed to be included, and that he addressed it in the morning meetings. He also stated that he gives the unit nurse manager a list of residents who need their weights taken, and even if he did not, they should be aware that their weekly weights still need to be included. When asked to clarify who is responsible for taking the weekly weights, he said that when residents get admitted , they have an order placed into the electronic system for weekly weights that need to be done. It is the responsibility of the admitting nurse or unit manager to verify that an order for weekly weights is placed upon admission. In an interview conducted on 11/08/23 at 4:20 PM, the Director of Nursing stated that in the morning meetings, Staff E will request the weights on residents that need to be done and are not done. Staff E provides them with a list of all weekly and monthly weights that are due for the day. In an interview with Staff V, the Minimum Data Set Coordinator, on 11/09/23 at 12:42 PM, stated that Resident #111 only needs set-up assistance with his eating. This means that the staff can bring the tray into the room, set it up for the Resident, and the Resident can eat on his own. Staff V further reported that this information is obtained by observing the residents, interviewing the staff, and reviewing documentation based on some evaluations. He further said that he observed the staff sitting near Resident #111 and that he could eat on his own. In an interview conducted on 11/09/23 at 12:55 PM with Staff U, CNA stated that Resident #111 needs assistance with all his meals and that a staff member has to sit with him during the meals. When asked by the Surveyor if Resident #111 could eat independently, she said, You need to feed the Resident. 2) Resident #143 was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses of Anemia, Diabetes, and Muscle weakness. The Order Summary Report showed an order for Boost Glucose Control three times a day for nutritional supplementation and record the percentage consumed dated 08/11/23. The Quarterly Minimum Data Set assessment dated [DATE] showed that Resident #143 has a BIMS score of 15, which indicated he is cognitively intact. Resident #143 was initially admitted to the facility on [DATE], readmitted on [DATE], readmitted on [DATE], readmitted on [DATE], and readmitted on [DATE]. A review of the Weight Log showed the following weights for Resident #143: on 03/17/23, a weight of 159.6 pounds, 122.0 pounds on 08/16/23, 124.2 pounds on 09/19/23 and dropped to 111.4 pounds on 10/05/23, which was 10% weight loss in less than a month. In an interview conducted on 11/07/23 at 1:10 PM, Resident #143 was noted eating his lunch meal in his room. He was observed eating 75% of his meals. In this observation, Resident #143 stated he used to get nutritional supplements (Boost) but has not gotten any in the last two weeks. He said that it was Boost with vanilla or chocolate flavors. Resident #143 stated that he needs to get more on his trays; sometimes, he feels insufficient and wants larger portions. In an observation conducted on 11/08/23 at 8:35 PM, Resident #143 was observed with his breakfast tray. Closer observation did not show any nutritional supplement on the tray. Resident #143 was observed eating 100% of his breakfast tray. In this observation, Resident #143 stated that he is not getting enough food and that he wants more. He then said, I can eat a lot. A Dietary progress note dated 10/06/23 revealed that Resident #143 had a good intake of meals between 75-100% of meals consumed. It showed that he is provided with Boost supplements three times a day. Further review did not show that the significant weight loss of 10% was addressed in this note. A Dietary progress note dated 10/13/23 revealed that Resident #143 had a good intake of meals between 75-100% of meals consumed. It showed that he is provided with Boost supplements three times a day. Further review did not show that the significant weight loss of 10% was addressed in this note. A Dietary progress note dated 10/20/23 revealed that Resident #143 had a good intake of meals between 75-100% of meals consumed. It showed that he is provided with Boost supplements three times a day. Further review did not show that the significant weight loss of 10% was addressed in this note. During an interview conducted on 11/08/23 at 9:55 AM with Staff G, Licensed Practical Nurse, who was asked when and how often a new resident is weighed, she stated they are weighed when they first come in and then weekly for four weeks, then monthly. During an interview conducted on 11/08/23 at 10:05 AM with Staff H, a Registered Nurse, who was asked when and how often a new resident is weighed, he stated the Resident is weighed right away on admission and then weekly on Tuesdays for at least four weeks so if there is any weight loss, they can correct it right away. In an interview conducted on 11/08/23 at 10:45 AM, Staff E stated that they only have two Hoyer lifts in the facility for taking the weights, with one not working and the other Hoyer lift broken all last week. They also have two stationary scales, with one not working, and the only stationary scale that is working is on Unit A. When asked who is responsible for the accuracy of the scales or calibration, he said, I do not know. In an observation conducted on 11/08/23 at 10:50 AM, the stationary scale showed that the scale was calibrated on 01/16/23 and that the next due date was supposed to be on 07/2023, which still needs to be done. In an interview conducted on 11/08/23 at 11:00 AM with Staff A, Unit Manager, it was stated that the Hoyer lift that was not working last week was just fixed and is now working. Staff E then said, Oh, I did not know that the Hoyer lift was fixed. In an interview conducted on 11/08/23 at 1:00 PM with Staff H, he stated that the nutritional supplements are taken from the supply room on the unit. He then proceeded to go into the supply room with the Surveyor. He said that before they run out of supplies, he will let staff know if they are low on a specific item. When asked who oversees ordering the nutritional supplies, he said it changes daily and that he did not know. He further said that he did not have a par-level list of what is needed on a daily or weekly basis and that he knows what is missing or what they are low stock on just by visually looking. He then said, for example, look at the Boost glucose control; we only have five bottles left. The Surveyor then said, Are you not going to let supply know that you are low, and he said, I will. An interview conducted on 11/08/23 at 4:27 PM with the Administrator revealed they purchased two new Hoyer lift scales that are in transit and that she rented the Hoyer lift scale for the A unit so they can take the weights. In an interview conducted on 11/08/23 at 4:35 PM with the Maintenance Director, he stated that he was unaware that the scales on the floor needed to be fixed or needed calibration. He further said that he could be contacted by staff, or the team could contact the vendor directly, but he was not aware of any vendors coming in to fix the scales. He further said that in May 2023, he reached out to his vendors, who came out and inspected all the scales, and any work orders were addressed at that time. In an interview conducted on 11/09/23 at 8:14 AM, Staff E stated that he did not see Resident #143 or speak to Resident #143 when he made his dietary progress notes on 10/06/23, 10/13/23, and 10/20/23. These notes were done after he reviewed Resident #143's nutritional progress in the Interdisciplinary Team meetings. When asked by the Surveyor if he was aware of the weight loss from 124.2 pounds to 111.4 pounds, he said yes. Staff E reported that he questioned the accuracy of the weight loss in the meetings and would follow up with a reweigh, but he never did. When asked why he did not go to see Resident #143, he said since he was eating well and meeting his nutritional needs, he did not. Regarding the dietary supplements, he stated that they are not placed on the meal trays but are given by nursing staff. In an interview conducted on 11/09/23 at 8:40 AM, the Corporate Dietitian stated that there are processes in place to ensure that weekly weights and monthly weights are done, and that is why they have the Interdisciplinary Team meetings to discuss any significant weight changes. Nursing takes the weights of all residents, and it is given back to the Dietitians to place them into the electronic system or the Unit Manager.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to monitor the nutritional status in a timely manner and failed to conduct weekly weights as per the facility's policy to identify a significant weight loss of 21% of body weight for 1 of 2 sampled residents reviewed for tube feeding (Resident #169). The findings included: A review of the facility's policy titled Weight Management, dated October 2021, showed the following: Weights are completed on admission and readmission, then weekly for four weeks, then monthly unless the physician orders is to reweigh more frequently. The Director of Nursing and Dietitian are to review the monthly and readmission weights and identify any resident requiring reweighing. Weight Loss: All residents with weight loss of 5% in 30 days, 7.5% in 3 months, and 10% in 6 months require physician notification and resident/resident representative notification. Speech and Occupational Therapy are notified as needed. Documentation of notification(s) is documented in the progress note; the care plan and [NAME] are updated with interventions. A review of the facility's policy titled Nutrition Assessment and Progress Note, dated January 2023, showed that Residents will receive a comprehensive nutrition assessment by a registered dietitian of an authorized designee. Assessment and documentation of nutritional concerns are recorded in a timely manner in the medical record. The nutrition assessment is an in-depth evaluation of objective and subjective data related to an individual's food and nutrient intake, lifestyle, and medical history. Reassessment is completed quarterly, annually, and with significant change or readmission as needed. Progress notes are completed for intermittent documentation as required and with changes in nutrition status or care. A review of the job description of the Dietitian dated August 1, 2020, showed the following: The Dietitian is primarily responsible for the assessment and evaluation of the Resident's nutritional needs, provides recommendations for nutritional needs, and monitors the Resident's nutritional status in skilled nursing facilities/assisted living facilities providing counseling to residents and family to promote health, wellness, and disease control. Complete nutritional initial, quarterly, annual, and significant Resident change reviews. Review monthly and weekly weights to determine residents who have had a significant change. Complete nutritional reviews monthly on high-risk residents (significant weight loss/ gain, pressure ulcer, hemodialysis, and tube feeding). Assess nutritional needs, diet restrictions, and current health plans to develop and implement dietary care plans and provide nutritional counseling. Resident #169 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of Cerebral infarction, Schizoaffective disorder, and bipolar disorder. Progress readmission noted dated 10/19/23 showed the following: a history of malnutrition and dysphagia and is full code. The Resident previously resided in an Assisted Living Facility. The order review report showed an order for enteral feeding with Jevity 1.5 (tube feeding formulary type) running at 70 ml (milliliters) an hour until a total volume of 1260 ml infused in 24 hours. May turn for care and services and to start at 2:00 PM, and to verify infusing every shift dated 10/19/23. Another order was noted for weekly weights, every seven days for four weeks. The order is not a practitioner order but an order that is part of the care plan by nursing staff dated 10/18/23. It further revealed to record weights under the weight tab in the electronic system and to reweigh for change of 5 pounds in the last seven days. In an observation conducted on 11/06/23 at 8:15 AM, Resident #169 was noted in the room with a tube feeding Jevity running at 70 ml an hour. The tube feeding bottle showed that it was started the day before, on 11/05/23, at 3:00 PM. Continued observation showed that the tube feeding bottle was at the 350 ml mark out of a 1000 ml capacity bottle. This observation indicated that 650 ml of formulary was infused in about 17 hours. In an observation conducted on 11/06/23 at 11:00 AM, the tube feeding was noted on hold, and the bottle was noted at the 250 ml level out of the 1000 ml capacity bottle. Continued observation at 12:30 PM revealed that the tube feeding was still on hold and was noted at the 250 ml level. This observation showed that 750 ml of formulary was infused in about 20 hours. In an observation conducted on 11/06/23 at 2:30 PM, the tube feeding was still on hold, and the bottle was noted at the 250 ml level out of the 1000 ml capacity bottle. This revealed that only 750 ml of tube feeding was provided to Resident #169 in about 24 hours. Resident #169 received 1123 calories, which is only 59% of their estimated energy needs in the last 24 hours. In an observation conducted on 11/07/23 at 9:30 AM, Resident #169 was noted in the room with the tube feeding running at 70 ml an hour. The tube feeding bottle was noted at the 450 ml level out of a 1000 ml capacity bottle. The tube feeding bottle was started on 11/06/23, the day before, at 4:00 PM. This showed that 550 ml of formulary was infused in the last 17.5 hours. In an observation conducted on 11/07/23 at 11:45 AM, Resident #169 was noted in the room with the tube feeding running at 70 ml an hour. The tube feeding bottle was noted at the 300 ml level out of a 1000 ml capacity bottle. The tube feeding bottle was started on 11/06/23, the day before, at 4:00 PM. This showed that 700 ml formulary was infused in the last 20 hours. In an observation conducted on 11/07/23 at 2:20 PM, Resident #169 was noted in the room with the tube feeding running at 70 ml an hour. The tube feeding bottle was still at the 300 ml level out of a 1000 ml capacity bottle. The tube feeding bottle was started on 11/06/23, the day before, at 4:00 PM. This showed that Resident #169 received 700 ml of tube feeding in the last 23 hours. This provided 1050 calories, which was 55% of Resident #169's estimated caloric needs. In an observation conducted on 11/07/23 at 4:10 PM, Resident #169 was noted in his room with the tube feeding running at 70 ml an hour. The tube feeding started at 4:00 PM on 11/07/23 and was at the 1000 ml capacity bottle. In an interview conducted on 11/07/23 at 4:11 PM, Staff D, Licensed Practical Nurse (LPN), stated that the earlier 7:00 AM to 3:00 PM shift changed the new tube feeding bag and that it was already running when she came for her shift today. She further said that Resident #169 tolerates his tube feeding. In an observation conducted on 11/08/23 at 7:14 AM, the tube feeding was noted at the 250 ml mark out of a 1000 ml capacity bottle. It started at 4:00 PM the day before, which was dated 11/07/23. In an interview conducted on 11/08/23 at 7:20 AM with Staff C, LPN stated that Resident #169's tube feeding was running all night and was only stopped for water flushes. Resident #169 is tolerating the tube feeding well with no issues. When asked by the Surveyor as to what is the tube feeding order for Resident #169, she said that the tube feeding starts at 2:00 PM and stops at 10:00 AM the following day. She then said let me check the electronic system to ensure I have it correct. After looking at Resident #169's tube feeding orders, she reported that the order would start at 2:00 PM and run until it reached 1260 ml. Staff C said it needed to run for 18 hours, paused, and then said, This seems too early. I am so used to the 10:00 AM, 2:00 PM routine. According to Staff C, she does not let the tube feeding bag empty to change to a new tube feeding bottle. She changed the tube-feeding bottle with some tube-feeding formulary left at the end of the bottle. A review of the weight log for Resident #169 showed the following: 117 pounds dated 10/07/23, 117 pounds dated 10/12/23, and a weight of 120 pounds, which was dated 10/18/23 after his readmission to the facility on [DATE]. Further review of the weights did not show any additional weights that were taken for Resident #169 after his readmission to the facility. The Medication Administration Record for November 2023 showed that the tube feeding was administered as per the above order with no issues documented. The Nutrition Evaluation Comprehensive, dated 10/19/23, revealed that Resident #169 estimated needs are at 1636-1909 calories a day, 68-82 grams of protein a day, and 1636-1909 ml of fluids a day. The above tube feeding order will provide 1890 calories a day, 80 grams of protein daily, and 1957 ml of fluids daily. It further revealed that Resident #169's Ideal Body Weight was at 148, and his Body Mass Index (BMI) was noted at 18.8, which is low. In an interview with Staff E, Registered Dietitian, on 11/08/23 at 9:09 AM, he stated when residents get initially admitted , their weight is taken as soon as possible. After the initial weight is taken, the Resident's weights are supposed to be done weekly for four weeks and monthly after that. If he does not have the weekly weight, he will request it from the nursing staff. High-risk residents are those residents who are on dialysis, with pressure ulcers, tube feeding, and residents with malnutrition. If a resident has malnutrition, it is because the nutritional guidelines identified them. Staff E further stated that the nursing staff would take the weights in each unit. At the beginning of the month, when most of the monthly weights are done, he gives the nursing staff on the unit the list of residents who need their weights taken. Nursing will sometimes place the weights into the electronic system, and sometimes, it is given to him to input the weights in the electronic system. When asked how he knows which residents are missing their monthly or weekly weights, he said that there is an entry form that allows you to see who is missing any weights or when the weights were taken on specific residents. He will run this report every morning, and as per nutritional guidelines, he will monitor any weight losses of 2% in one week, 5% in one month, 7.5% in 3 months, and 10% in 6 months. Staff E reported that for any of the above weight loss percentages, the electronic system will initiate a warning on the specific weight loss. He then said, Sometimes the weight loss warning gets cleared in the electronic system by the nursing staff. In an observation conducted on 11/08/23 at 1:11 PM, Resident #169's weight was taken as requested by the Surveyor. A Hoyer lift scale was used to take the weight of Resident #169. Continued observation showed Staff I and Staff J, Certified Nursing Assistants, were in the room to take the weight of Resident #169, which showed a weight of 94 pounds. Resident #169's weight of 94 pounds in 20 days showed a significant weight loss from 120 pounds to 94 pounds, which was a 21 percent weight loss. This showed that Resident #169's BMI dropped from 18.8 to 14. 7, which is underweight. In an interview conducted on 11/08/23 at 2:30 PM with Staff H, Registered Nurse, he stated that he is very familiar with Resident #169 and has been tolerating his tube feeding very well in the last few weeks with no issues. He did say that Resident #169 has the tendency to move around, and he would always check on him to make sure that he did not strangle himself with the tube feeding around him. Staff H further stated that the tube feeding has been following the Physician's orders and that he starts it at 2:00 PM before he leaves his shift. The tube feeding order is to run until 1260 ml, or the formula is infused in 24 hours, running at 70 ml an hour. If the tube feeding had not been flushing, dislodged, or obstructed, he would have contacted the doctor, which did not happen. In another interview conducted on 11/08/23 at 4:03 PM with Staff E, he was asked as to how many bottles of feeding formulary are infused if the next day, after 23-24 hours, there is still some formula left in the bottle, he stated that it is okay because the tube feeding bottles are 1500 ml capacity bottles. He then said that if the tube feeding ran for 18 hours, it should have been done after 18 hours unless they stopped it to provide care. When asked about the 21% weight loss on Resident #169 from his readmission on [DATE], he stated, The Resident clearly has something that we did not know about, and that is for the doctor to figure it out. Staff E then said that he would follow up on Resident #169 to order a new lab and see why he needs to utilize the formula. He only realized it today when Resident #169 was placed on the scale that he had such a significant weight loss in 3 weeks. He further said that he addresses the issues with weights in the morning meetings and that some managers are more effective than others in making sure that he has the weekly weights to complete the nutritional assessments. The Surveyor expressed concern that the significant weight loss was missed within 3 weeks, and Staff E then said, It is only one week that he missed the weight on Resident #169. In an interview conducted on 11/08/23 at 4:50 PM with the Director of Nursing (DON), she stated that they have morning meetings daily, and she was not aware that some residents needed weekly weights that were not done. According to DON, Staff E would provide nursing staff with a list of any residents who needed the weekly or the monthly weights done. The care plan, which was initiated on 10/06/23, showed the following: to obtain adequate nutrition and hydration by administrating the enteral feeding as ordered. It further revealed that Resident #169 is at nutritional risk related to malnutrition, dysphagia, and low BMI. In an interview conducted on 11/08/23 at 6:00 PM with the facility's Administrator, she was told of the findings and that Resident #169 has a significant weight loss of 21%. She was told by the Surveyor that weekly weights were not obtained on high-risk residents and that Resident #169's weight loss was identified because of the Surveyor's interventions. In an interview conducted on 11/09/23 at 11:00 AM with the facility's Medical Director, he stated that Resident #169 went to the hospital on [DATE] for peg tube placement after Resident #169 was observed with a dislodged tube feeding. He further noted that Resident #169 did not get any nutrition via tube feeding for 3-4 days while in the hospital and was already compromised nutritionally. The Medical Director reported that Resident #169 was tolerating his tube feeding after he was readmitted to the facility on [DATE]. He further questioned the significant weight loss for Resident #169 and stated that he would investigate further and order more labs for any underlying causes that may have been missing.