Failure to Follow Dietician-Approved Menus and Provide Adequate Substitutions
Penalty
Summary
The facility failed to ensure that the dietician-approved menu was consistently followed and that adequate quantities of approved substitutions were available to all residents. Kitchen staff reported that when preparing meals, they sometimes lacked necessary ingredients and made substitutions, particularly with vegetables or fruits, without always obtaining prior approval from the Dietary Manager or Registered Dietician. Substitutions were sometimes made based on resident preferences, such as serving goulash instead of beef macaroni casserole, and additional portions of the main course were only provided if there was enough left after initial servings. The Registered Dietician confirmed that she was not always contacted regarding substitutions and only signed off on them during her visits, contrary to her expectation that planned menus be followed to meet residents' nutritional needs. Interviews with residents revealed dissatisfaction with the food, citing limited options, lack of choices, and insufficient portion sizes. The facility's policy required that food substitutes be of similar nutritive value and that the Food Services Department offer alternatives for residents who did not want the primary meal. However, the observed practices did not consistently align with these guidelines, as substitutions were not always approved or equivalent, and residents' preferences and needs were not fully met.