Failure to Provide Prescribed Therapeutic Diet and Adequate Portions
Penalty
Summary
The facility failed to provide a resident with a nourishing, palatable, well-balanced diet that met the resident's daily nutritional and special dietary needs, as prescribed by the physician. The resident, a male with multiple diagnoses including morbid obesity, acute respiratory failure, and various mental health conditions, was cognitively intact and had specific dietary orders for a regular diet with double portions of protein at all meals and double portions of vegetables at lunch and dinner. Despite these orders, multiple instances were documented where the resident did not receive the prescribed portions or appropriate food substitutions, as evidenced by photos of meal trays and tray tickets provided by the resident and reviewed by the Ombudsman and surveyors. Interviews with facility staff, including the Dietary Manager, Administrator, and DON, revealed a lack of clarity regarding what constituted a vegetable, with staff acknowledging that items like French fries and mashed potatoes were not considered vegetables. The Dietary Manager reported that recent budget cuts by the new management company limited the ability to purchase fresh food and provide alternative meal choices, resulting in insufficient food to meet double portion requirements. The kitchen inventory confirmed a limited supply of fresh and frozen vegetables, and the Dietary Manager stated she was only allowed to prepare food for the exact number of residents, not accounting for second helpings or special dietary orders. Facility policy required that all therapeutic diets be served according to physician orders, with substitutions made for allergies and preferences as reviewed by the registered dietician. However, the facility's food master list did not specify which foods were considered vegetables, and the registered dietician was unavailable for comment. The resident expressed concerns about not receiving full meals and attributed the issue to budget constraints and management decisions, which was corroborated by staff interviews and observations.