Failure to Assess and Document Resident's Food Preferences
Penalty
Summary
The facility failed to ensure that Resident #79 was provided with a nourishing, palatable, well-balanced diet that met their daily nutritional and special dietary needs, as well as their personal preferences. The resident, who had diagnoses including Cushing's syndrome, Type 2 Diabetes Mellitus, and Chronic Kidney Disease, expressed dissatisfaction with the food served, specifically noting that they were not assessed for food preferences and were served pork and beef, which they do not eat. The resident also reported not receiving a menu to choose their meals. A review of the resident's dietary assessments revealed no documentation of an assessment for food preferences, and the comprehensive care plan initially did not reflect the resident's dietary restrictions. Interviews with facility staff, including a dietician and a Licensed Practical Nurse (LPN), revealed that the resident's food preferences were not documented or assessed upon admission. The dietician stated that the resident did not want to endorse their food preferences initially, which led to the lack of documentation. The LPN noted that the resident would refuse meals and express dissatisfaction afterward, and the resident did not receive a menu. The General Manager from the dietary services contract company confirmed that food preferences should be documented in the resident's medical record and that a menu should be provided to alert and oriented residents. The Director of Nursing Services acknowledged that if a resident chooses not to endorse food preferences, this should be documented in the medical record and reflected in the comprehensive care plan.
Plan Of Correction
Plan of Correction: Approved January 10, 2025 I. The following actions were accomplished for the residents identified in the sample: Resident #79 On 12/09/24, the Dietitian met with Resident #79 to discuss his/her food preferences and updated his/her food preferences in the meal tracker. On 12/9/24, a full house preference check was completed with information entered into meal tracker and scanned copies of preference sheets kept in binder in RD office. II. The following corrective actions will be implemented to identify other residents who may be affected by the same practice: All residents have been identified as potentially being affected by the same practice. Effective 12/11/24, in-service education was provided to RDs related to obtaining residents’ food preferences upon admission, and at least quarterly, and appropriate documentation of same by Regional Dietitian. Food preference sheets will be maintained in the RD office in the binder. III. The following system changes will be implemented to assure continuing compliance with regulations: The Director of Clinical Nutrition reviewed and revised, as needed, the Clinical Nutrition policies and procedures related to completing a comprehensive nutrition assessment, including obtaining residents' food preferences and entering same into meal tracker, plus procedure for providing menu to residents. The Chief Nursing Officer reviewed and revised, as needed, policies and procedures related to nursing staff reporting any changes to food preferences identified during meals to RD and food service staff. Effective 12/30/24, the Director of Clinical Nutrition/Designee will implement chart auditing specifically to monitor for obtaining and honoring food preferences as part of clinical nutrition assessment upon admission, at least quarterly, and as preference changes arise, and that this information is up to date and accurate in food preference binder kept in RD office and meal tracker. Dietitians will make meal rounds regularly to obtain feedback from residents at meal time, and this will be monitored by Director of Clinical Nutrition/Designee. The Director of Clinical Nutrition/Designee will also audit to ensure that all residents who meet the criteria to receive menu receive same, and review criteria to ensure it captures all eligible residents. Effective 12/30/24, the Director of Clinical Nutrition will monitor obtaining and provision of food preferences during sample chart reviews and resident interviews on a Monday through Friday basis for 4 weeks, weekly for 2 months, then quarterly. Corrective action, including staff re-education, updating of the CCP or documenting a nutritional progress note, will be implemented as necessary. Residents from all units will be included in the sample. The Staff Educator/Director of Clinical Nutrition/designee will provide additional education to all nursing and dietary staff whenever issues related to residents’ food preferences are identified. IV. The facility’s compliance will be monitored utilizing the following quality assurance system: The facility will develop an audit tool to monitor compliance with obtaining, providing, and updating residents’ food preferences. The Director of Clinical Nutrition/Designee will monitor that residents’ food preferences are obtained and provided monthly for three months then quarterly for the next three quarters. The Director of Clinical Nutrition/Designee will conduct competency evaluations of all RDs to ensure they are following established protocols and have a clear understanding of the protocols related to food preferences. On-site education will be provided as necessary to ensure staff compliance. Competency evaluations will be conducted on all new RDs upon completion of orientation and twice yearly thereafter. The Director of Clinical Nutrition will review findings with the Administrator monthly for three months then quarterly. The Director of Clinical Nutrition/designee will report food preference audit findings to the QAPI Committee monthly for the next 3 months then quarterly for the next 3 quarters. At the end of the fourth quarter, a decision will be made by the QAPI Committee regarding the need to continue auditing and at what frequency. Additional corrective action will be implemented as deemed necessary by the QAPI Committee. Completion Date: 01/31/2025 Responsibility: Director of Clinical Nutrition