Failure to Provide Physician-Ordered Therapeutic Diets and Fortified Meals
Penalty
Summary
The facility failed to consistently provide physician-ordered therapeutic diets to three sampled residents. Specifically, two residents with diagnoses including major depression, anemia, fatigue, dementia, and adult failure to thrive were not consistently provided with fortified meals as ordered by their physicians. Observations revealed that while some meals, such as breakfast, were fortified, other meals like lunch and dinner were not, despite the meal tray tickets indicating a fortified diet. The Certified Dietary Manager (CDM) confirmed that not all meals were fortified, and the Registered Dietician (RD) stated that every meal should have been fortified according to the care plan and physician's orders. For one resident with Alzheimer's, dementia, and type 2 diabetes with diabetic neuropathy, the facility failed to provide double portions of protein as ordered. Observations and interviews with the resident's responsible party indicated that the resident was not consistently receiving double portions of protein, particularly during dinner, and staff had to obtain additional food to meet the order. The CDM acknowledged ongoing issues with the evening cook not providing double portions and confirmed that no resident lunches had been fortified. The facility's policy required that therapeutic diets be provided as prescribed by the attending physician to support the resident's treatment and plan of care. However, the facility did not adhere to these requirements, resulting in residents not receiving the necessary fortified meals or double protein portions as ordered. These failures were confirmed through observations, interviews with staff and responsible parties, and review of physician orders and care plans.