Failure to Offer Substitute Meal After Resident Refusal
Penalty
Summary
A deficiency occurred when a resident with multiple comorbidities, including cerebral palsy, was not offered a substitute meal after refusing the meal provided on the menu. The resident was on a regular diet and was independently able to eat, as documented in the electronic medical record. The care plan included interventions to update preferences and provide a liquid supplement three times daily. Despite these interventions, direct observation revealed that a CNA removed the resident's untouched meal tray without offering an alternative meal. The CNA confirmed that no substitute was offered, stating that the resident never eats anything. Interviews with the resident confirmed that no alternative was offered after the meal was refused. The Registered Dietitian, Administrator, and DON all stated that their expectation was for staff to offer substitute meals to residents who refuse or consume less than 25% of their meals. However, the staff did not follow this protocol, resulting in the resident not being provided with an alternative meal option as required by facility policy and standard practice.