Failure to Provide HS Snacks Results in Prolonged Fasting Periods
Penalty
Summary
Facility staff failed to provide HS (hours of sleep) snacks to residents on both the Dogwood and Rosewood units, resulting in a prolonged interval of over 14 hours between the evening meal and breakfast. The facility's meal delivery schedule indicated that dinner was served between 4:30 p.m. and 5:15 p.m., and breakfast was not served until 7:30 a.m. to 8:00 a.m. the following day. Resident council presidents from both units confirmed that residents were not offered snacks during the night shift and that the council had not agreed to allow up to 16 hours between meals. Staff interviews revealed that snacks were not consistently provided due to staffing shortages, and dietary staff reported that while snacks were prepared and delivered to the nurse's stations, nursing staff did not always distribute them to residents. Further documentation and communication between dietary and administrative staff highlighted ongoing concerns about the failure to pass out snacks, with photographic evidence and emails indicating that snacks remained undistributed. Despite the dietary department fulfilling its responsibility to supply snacks, nursing staff did not consistently ensure residents received them. Multiple staff members, including CNAs and nurse managers, either did not recall being informed about the issue or acknowledged that snack distribution was inconsistent. No additional information was provided by facility leadership prior to the survey exit.