Failure to Follow Menu and Fluid Restriction Orders
Penalty
Summary
The facility failed to follow the planned menu for a finger foods diet for one resident during lunch trayline. The resident's meal tray card and care plan indicated a finger food diet, which required foods to be cut into bite-sized pieces to allow for self-feeding and maintain independence and dignity. However, a whole piece of chocolate cake was served instead of being cut into smaller pieces as specified in the therapeutic diet spreadsheet and menu extension. The registered dietitian acknowledged that the menu was not followed and that she had not identified concerns with the finger foods menu in advance to provide proper instruction to dietary staff. Additionally, the facility did not ensure that the allotted fluid restriction for another resident was followed as ordered. The resident, who had end stage renal disease and was on a fluid restriction, had a care plan specifying a daily fluid limit with specific amounts to be provided by dietary and nursing. During review, it was found that the meal tray card did not provide the full amount of fluid allotted by dietary, resulting in the resident receiving less than ordered. The dietary supervisor confirmed that the resident had been receiving less fluid than prescribed and noted that the resident had expressed thirst. Both deficiencies were identified through observation, interview, and record review, and were supported by facility policies, job descriptions, and diet manuals that outlined the requirements for menu preparation, diet orders, and fluid restrictions. The failures were related to not following established dietary protocols and not providing the prescribed diet and fluids as ordered for the residents involved.