Failure to Serve Meals According to Residents' Menu Preferences
Penalty
Summary
Surveyors identified that the facility failed to serve meals according to predetermined menus that reflected residents' preferences, as evidenced by multiple dining observations and record reviews. Residents' meal trays were missing items listed on their meal tickets, such as vanilla ice cream, salt, pepper, milk, low-fat yogurt, cottage cheese, and bananas. These omissions were confirmed through direct observation, resident statements, and interviews with dietary staff. Residents also voiced concerns and grievances during food committee meetings about not consistently receiving meals as ordered. Staff interviews revealed that the occurrence of missing food items depended on which dietary staff member loaded the meal cart. The dietary manager and a dietary aide both acknowledged the issue of missing items on residents' trays. The deficiency was observed across several meals and residents, indicating a pattern of not following the established menu and residents' documented preferences.