Failure to Provide Prescribed Snacks and Inadequate Snack Distribution Process
Penalty
Summary
The facility failed to ensure that residents received suitable and nourishing meals and snacks outside of scheduled meal service times, as required by their physician orders and care plans. Specifically, three residents with significant medical conditions, including muscle wasting, diabetes, malnutrition, and dysphagia, were not consistently offered or provided with prescribed snacks at bedtime or as otherwise ordered. Documentation on the Medication Administration Record (MAR) and Treatment Administration Record (TAR) was incomplete or missing for these prescribed snacks, and there was no evidence that the required snacks were consistently provided. Observations and interviews revealed that the process for distributing snacks was disorganized and inconsistent. Kitchen staff prepared snacks and left them at the nurse's station, often without labeling them with residents' names, except for those with specific physician orders. Staff interviews indicated that snacks were sometimes taken by residents from other units, and that agency staff or new staff were not always aware of residents' preferences or locations, resulting in missed snacks. There was confusion among staff regarding responsibility for snack distribution and documentation, with some believing it was the responsibility of CNAs, while others thought nurses or medication aides should be involved. Further, there was no set menu for snacks, and the dietary manager and registered dietician had not established clear procedures or oversight for snack provision. The dietary manager reported a lack of control over snack distribution after they left the kitchen, and the registered dietician was unaware of the issues. The facility did not provide a snack policy when requested, and staff interviews indicated that the labeling and tracking of snacks had become less consistent over time. These failures resulted in residents not receiving snacks as ordered, with some residents reporting they had not been offered snacks for an extended period.