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F0803
D

Failure to Follow Resident Menu Preferences and Communicate Food Substitutions

Honolulu, Hawaii Survey Completed on 05-01-2025

Penalty

No penalty information released
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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

The facility failed to ensure that a resident's menu selections and food preferences were followed, resulting in the resident receiving a meal that did not match his advance selections and included items he did not want. The resident, who has documented allergies to pineapple and turkey, had selected beef tomato, rice, and mandarin oranges for lunch, as indicated on his posted menu. However, the kitchen substituted chicken and cauliflower for the selected items without prior communication or explanation to the resident. The substitution was made because the beef tomato contained pineapple, and the alternative entrée, turkey burger, was also not suitable due to the resident's allergy. The resident was not informed of these changes or given the opportunity to choose from other available menu options prior to being served. During the lunch observation, the resident expressed confusion and dissatisfaction with the meal provided, noting that his selected items had been crossed out and replaced without his input. The resident only learned after the fact that the substitution was due to his allergies, and he was not approached beforehand to discuss alternative choices. The lack of communication and failure to follow the resident's documented food preferences led to the resident receiving a meal he did not want, causing confusion and dissatisfaction during the dining experience.

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