Failure to Honor Documented Food Preferences During Meal Service
Penalty
Summary
The facility failed to honor the documented food preferences of a resident who was admitted with diagnoses including hemiplegia and hemiparesis and had an intact cognitive status, as indicated by a BIMS score of 15. The resident's clinical record and meal ticket specifically listed multiple vegetable dislikes, including broccoli, carrots, and cauliflower. Despite these documented preferences, the resident was served a meal containing a California blend of vegetables that included the items he disliked. During observation, the resident was seen removing these vegetables from his plate and reported that this issue occurred frequently, despite his preferences being documented. Interviews with facility staff revealed that dietary staff did not review or acknowledge food preferences listed on residents' meal tickets. The Dietary Manager, who had been in the role for less than ninety days, confirmed that staff had not been trained to consistently review or implement resident preferences during meal service. The Administrator acknowledged that the dietary department was newly staffed and that the Dietary Manager was still learning his responsibilities, resulting in the failure to ensure meals were prepared according to residents' documented preferences.