Failure to Provide and Follow Therapeutic and Portion-Specific Menus
Penalty
Summary
The facility failed to ensure that menus met the nutritional needs of residents, were prepared in advance, followed, updated, and reviewed by a dietitian, and that they met the specific needs of each resident. Observations and interviews revealed that menu spreadsheets for portion sizes and therapeutic diets were either missing or not followed for several residents. The general menus in use did not match the planned menu spreadsheets and lacked details for therapeutic diets and portion sizes. Staff relied on old menus and verbal instructions for serving sizes, and there was no consistent documentation or guidance for preparing meals according to residents' prescribed diets. For three residents reviewed, there were discrepancies between their prescribed diets and the meals served. One resident with a pureed, renal, and large portion diet was served meals that did not align with a renal or pureed menu, and the breakfast menu did not include a pureed or renal option. Another resident on a mechanically altered, no added salt diet received a meal that did not correspond to a mechanically altered menu. A third resident on a carbohydrate-controlled, no added salt diet was served a meal that did not reflect a CCHO menu. In each case, the general menu used did not provide for the specific dietary needs or textures required by the residents' orders. Interviews with the kitchen manager and registered dietitian confirmed that menu spreadsheets for the current menus were still being developed, and staff were using old menus or making substitutions without proper documentation for side dishes or portion sizes. The kitchen manager admitted to not having clear spreadsheets for staff to follow and instead provided verbal instructions on serving sizes. The lack of up-to-date, detailed menus and portion guidance led to inconsistencies in meal preparation and serving for residents with therapeutic and texture-modified diets.