Failure to Serve Proper Meal Portions to Residents
Penalty
Summary
Facility staff failed to serve proper portion sizes to residents during meal service, as observed during a meal preparation and service. Staff A prepared pureed meals by combining multiple servings of meat, potatoes, roll, and gravy, as well as spinach, but did not accurately measure the portions according to the residents' dietary requirements. Instead of providing the prescribed two #8 scoops of the pureed mixture per resident, Staff A served only one scoop of each mixture to two residents, leaving extra food in the pan. When questioned, Staff A was unable to confirm the exact measurements used and admitted to estimating portion sizes based on visual cues rather than precise measurement. Additionally, approximately ten plates were served with smaller, unmeasured portions because residents reportedly requested half servings, but only one resident was care planned for half portions. Interviews with the Dietary Manager and review of facility policies confirmed that staff are expected to serve full portions unless otherwise ordered and documented in the care plan. The Dietary Manager acknowledged that Staff A should have served the correct portions and that only one resident was authorized for half portions. Facility policy also specifies that pureed foods should not be combined unless requested and documented, and that meals should be well-balanced and provide adequate nutrition. The Administrator confirmed that staff are required to serve proper amounts as ordered.