Failure to Honor Food Preferences and Meal Timing for Dialysis Resident
Penalty
Summary
The facility failed to honor a resident's food preferences and accommodate alternate meal times for a resident undergoing renal dialysis. The resident, who had diagnoses including type II diabetes mellitus, heart failure, and end stage renal disease with dialysis, reported that despite informing two dietitians of her preference for no bread and a small salad at lunch and dinner, she continued to receive bread and often did not receive the requested salads. Meal tickets reflected her preferences, but observations showed that her trays did not consistently match these requests. For example, her lunch tray did not include the salad and dressing as indicated, and her dinner tray included bread products despite her request for no bread. Additionally, the resident's dinner tray was routinely left at her bedside while she was out for dialysis, contrary to facility policy, which required that trays not be left unattended in resident rooms. Staff interviews confirmed that the meal was left for her to eat upon return, sometimes hours later, and that the system for ensuring food preferences and proper meal delivery was not consistently followed. The dietary and nursing staff acknowledged the resident's requests and the discrepancies, and the facility's policies outlined procedures that were not adhered to in this case.