Failure to Follow Dietary and Fluid Restriction Orders
Penalty
Summary
The facility failed to follow established nutritional interventions and dietary orders for several residents, resulting in deficiencies in the provision of adequate food and fluids. Three residents with specific dietary needs, including large portions for wound healing and malnutrition, and the addition of yogurt or cottage cheese for weight gain, did not consistently receive the prescribed food portions or supplements. Observations and interviews revealed that residents who were supposed to receive double or large portions were served meals of the same size as other residents, and one resident did not receive the ordered yogurt or cottage cheese with meals. Staff interviews confirmed that the intended larger portions were not being provided, and the dietary staff did not consistently follow meal tickets or care plans specifying these interventions. Additionally, the facility failed to ensure that a fluid restriction order was followed for a resident with hyponatremia. The resident was observed drinking fluids freely from large containers, and staff reported that they were unable to monitor her intake because she was independent in obtaining fluids. There was no documentation of education or risk versus benefit discussions with the resident regarding the importance of adhering to the fluid restriction. The resident herself stated that she had not received any education from facility staff about her fluid restriction or its significance. Facility policies were reviewed and indicated that food and nutritional needs should be met according to physician orders, and that therapeutic diets should be prepared and served as prescribed. However, the observed practices did not align with these policies, as residents did not receive the prescribed diets or fluid restrictions. The lack of adherence to dietary and fluid orders was confirmed through staff interviews, resident statements, and direct observation of meal service and resident behavior.