Failure to Honor Resident Food Preferences and Dietary Orders
Penalty
Summary
The facility failed to honor a resident's documented food preferences and dietary needs as identified on the meal tray card and care plan. Despite the resident being cognitively intact and having specific dietary restrictions and preferences due to medical conditions such as Myasthenia Gravis, dysphagia, and a history of aspiration, the resident consistently received food items that were either disliked or not suitable for their condition. Observations revealed that the resident was repeatedly served dried toast, which was listed as a disliked item, and was not provided with the prescribed fortified cereal, even though these preferences and requirements were clearly documented in the care plan and physician orders. Interviews with the resident, nursing staff, and the registered dietician confirmed that the resident's preferences were not being followed, and that staff were expected to verify meal trays against the meal tickets before delivery but failed to do so. The resident reported having to request preferred food items regularly and often received meals that could not be safely chewed or swallowed. The registered dietician also acknowledged that the resident should not have been receiving bread items and confirmed the absence of the fortified cereal as ordered. These failures occurred despite facility policies requiring the identification and honoring of resident food preferences.