Failure to Provide Nourishing Evening Snacks
Penalty
Summary
The facility failed to provide a nourishing evening snack when more than 14 hours elapsed between the supper meal and breakfast the next day for residents, including three sampled residents. The facility's policy, dated 12/9/24, stated that bedtime snacks should be offered and served according to residents' needs, preferences, and requests. However, the facility's meal schedule showed a 15.5-hour gap between dinner and breakfast, and interviews with residents and staff confirmed that snacks were infrequently provided and not documented unless ordered by a physician. The deficiency involved three residents with various medical conditions, including diabetes, dysphagia, and cognitive deficits. Reviews of their clinical records and physician orders revealed no documentation or orders for evening snacks. Additionally, the facility failed to obtain resident group acceptance for a meal span greater than 14 hours, as indicated by the absence of such documentation in the Resident Council Minutes. The Nursing Home Administrator confirmed these findings during an interview.
Plan Of Correction
1. Meal times will be adjusted to meet the requirements of the 14 hour rule. 2. NHA/designee to educate Dietary Manager on 14 hour rule requirement, and if meal times were to exceed 14 hours, then the presence of a substantial snack is required. 3. Dietary Manager/designee to educate dietary staff on 14 hour rule requirement, and if meal times were to exceed 14 hours, then the presence of a substantial snack is required. 4. Dietary Manager/designee to audit meal times and snacks for all 3 meals 3x/week for 3 weeks, and 1x/week for 3 weeks thereafter. 5. Results to be submitted to QAPI for review and approval.