Failure to Provide Ordered Nutritional Supplement with Meals
Penalty
No penalty information released
The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.
Summary
A deficiency occurred when a resident with no capacity to understand and make decisions, who had a physician's order to receive a four-ounce health shake three times daily with meals, did not receive the ordered supplement. Medical record review confirmed the order was in place, and observations on two separate occasions showed that the health shake was not present on the resident's meal tray, despite being listed on the meal ticket. Interviews with CNAs confirmed that the health shake was missing from the tray during both lunch and breakfast. The Director of Nursing also verified that the resident had not been receiving the health shakes as ordered.