Failure to Provide Physician-Ordered Fortified Meal Plan
Penalty
Summary
The facility failed to provide a fortified meal plan (FMP) as ordered by the physician and dietician for one resident with significant medical needs, including vascular dementia, cerebral infarction, and chronic kidney disease. The resident was assessed as having severe cognitive impairment and was prescribed a therapeutic diet, specifically a FMP, due to nutritional concerns and a history of weight loss and low albumin levels. Despite these orders, the resident's meal ticket did not reflect the FMP requirement, and staff were not alerted to provide the necessary fortified meals. Observations and interviews revealed that the nursing and dietary staff relied on the meal ticket to guide meal preparation and serving. The LVN and ADON both confirmed that the absence of the FMP notation on the meal ticket meant staff were unaware of the need to provide extra calories, fats, and carbohydrates as part of the resident's meal. The Food Service Manager acknowledged receiving the FMP order and noted that the dietary database indicated the resident required a FMP, but could not explain why the meal ticket failed to include this information. As a result, the resident was not served meals in accordance with the physician's and dietician's orders. The facility's policy requires that therapeutic diets be provided as ordered by the physician and according to the service plan. However, the breakdown in communication and failure to update the meal ticket system led to the resident not receiving the prescribed fortified meal plan over an extended period. This deficiency was identified through record review, staff interviews, and direct observation of meal service.