Failure to Provide and Communicate Alternative Meal Options
Penalty
Summary
The facility failed to provide food that accommodated resident preferences and did not consistently offer or communicate appealing alternative meal options to residents who declined the food initially served. Several residents, including those with intact cognitive abilities and those with communication deficits, reported not being aware of available meal substitutes or how to request them. For example, one resident with dysphagia, anxiety, and deafness communicated via writing that he was unaware of meal options beyond what was served and did not know what vegetable substitutes were available. Another resident with diabetes, anxiety, and autism expressed uncertainty about what would happen if he did not eat the served meal and was also unaware of food substitute options. Staff interviews revealed inconsistent knowledge and practices regarding alternative meal options. Some staff members, including CNAs and cooks, were unsure of what alternatives were available or where such options were listed. The dietary manager confirmed that a list of alternatives existed but was not posted or provided to residents, being kept only in a kitchen binder. Staff generally relied on their knowledge of resident preferences or pocket care plans, but did not consistently offer alternatives unless specifically requested, and alternatives were not clearly communicated or visible to residents. Observations during meal service showed that when a resident refused a food item, such as corn, staff did not always offer an alternative, and in some cases, staff were unsure what alternatives could be provided. The menu board listed only the main meal, and there was no system in place for residents to select or be informed of alternative options. Documentation in the admission packet stated that food preferences would be considered, but in practice, residents were not consistently assisted in exercising choice regarding their meals.