Failure to Follow Menu and Meal Tickets Results in Nutritional Deficiency
Penalty
Summary
The facility failed to follow the planned menu and meal tickets for three residents during a lunch service, resulting in meals that did not meet the nutritional needs as specified. Observations and interviews revealed that the kitchen staff did not serve the correct menu items or toppings as indicated on the residents' meal tickets. For example, one resident was not served cheese sauce and shredded lettuce with her chicken fajita, and the rice provided was plain steamed rice instead of the required green chili rice. Another resident did not receive the shredded lettuce and diced tomato topping, and the fiesta corn and green chili rice were not prepared according to the recipe. A third resident was served a square of cake instead of a sugar cookie, and the rice and corn were also not prepared as specified in the menu. The report details that the kitchen staff made unauthorized substitutions and omissions without following the facility's policy for menu changes, which requires approval from the Dietary Services Supervisor (DSS) and Registered Dietitian (RD). The staff failed to document these substitutions in the Menu Substitution Log, and the recipes for the menu items were not followed. The Dietary Services Supervisor and the cook acknowledged that the correct procedures were not followed, often citing being busy as the reason for these lapses. The Director of Nursing (DON) confirmed that all meals should be served as indicated on the meal tickets and that recipes are standardized to meet residents' nutritional needs. The residents involved had significant medical histories, including chronic pain syndrome, protein-calorie malnutrition, diabetes, and muscle wasting. Their care plans and physician orders required specific diets and assistance with meals. The failure to provide the correct menu items and follow standardized recipes resulted in meals that lacked required nutrients and flavor, as directly observed and reported by staff and residents. The facility's policies on menu planning and recipe standardization were not adhered to during the meal service in question.