Failure to Follow Individualized Meal Tickets and Food Preferences
Penalty
Summary
Surveyors identified that the facility failed to ensure that food preferences and individualized meal tickets were consistently accommodated for ten out of sixteen sampled residents. Observations, interviews, and record reviews revealed that staff did not follow specific dietary orders and preferences as indicated on residents' meal tickets. For example, one resident on a cardiac diet received a full-size brownie and a white roll instead of the specified half brownie and wheat roll, and another resident with dysphagia did not receive margarine, cabbage, or a frosted brownie as listed on their meal ticket. Additionally, several residents did not receive the beverages indicated on their meal tickets, such as milk, coffee, or juice, during lunch service. Staff interviews confirmed that beverages and other meal components were not always provided as required by the individualized meal tickets. Some staff indicated that residents could have whatever beverages they wanted unless on a fluid restriction, while others acknowledged that the meal tickets should be followed. The Director of Nursing and Dietary Manager both confirmed that staff are expected to follow the meal tickets and provide the items listed, including correct portion sizes and substitutions for allergies or preferences. The Dietary Manager also reported issues with food supply, such as the unavailability of margarine and the substitution of cucumber salad for coleslaw due to a delayed food delivery. Despite these supply issues, the expectation remained that meal tickets should accurately reflect what residents receive and that staff should follow them as written. The failure to provide meals and beverages according to individualized meal tickets resulted in residents not receiving their prescribed diets, preferences, or required nutritional items during meal service.