Failure to Follow Physician-Ordered Therapeutic Diets
Penalty
Summary
The facility failed to follow physician-prescribed therapeutic diet orders for multiple residents, as evidenced by observations, interviews, and record reviews. On specific dates, residents on a Heart Healthy diet were served food items not consistent with the facility's dietary spreadsheet, such as being given regular bread stuffing instead of the prescribed seasoned pasta. The Registered Dietitian (RD) and Director of Nursing (DON) both confirmed that dietary staff are required to follow the cook spreadsheet and physician orders for therapeutic diets, and that deviations could affect residents' health. Six residents were identified as being on a Heart Healthy diet according to physician orders, and the facility's own policies require strict adherence to these orders. Additionally, residents on Renal and Liberal House Renal diets were served wheat rolls instead of the bread or roll (no whole grain) specified in the dietary spreadsheet. Multiple observations and interviews with kitchen staff revealed that wheat rolls were prepared and served to all residents except those with a wheat allergy, despite the RD's statement that renal diet residents should not receive wheat rolls due to potential effects on blood electrolytes. The Assistant Dietary Supervisor and kitchen staff confirmed that only wheat rolls were available and served, except for one resident with a wheat allergy who received white bread. The facility's policies and procedures, as well as the dietary spreadsheets, clearly state that therapeutic diets must be prepared and served as prescribed by the attending physician and planned by the RD. The failure to follow these orders and serve the correct food items for therapeutic diets was confirmed through direct observation, staff interviews, and review of physician diet orders and facility policies.