Failure to Follow Resident Meal Tickets and Menu Postings
Penalty
Summary
The facility failed to ensure that dining staff followed resident meal tickets for four residents, resulting in residents not receiving items listed on their menus. During dining observations, two residents were not served broccoli salad as indicated on their meal tickets, and one resident reported not receiving garlic bread, with no substitutions provided. Review of posted menus confirmed that these items were scheduled to be served, and the postings were not updated to reflect any changes or substitutions. Additionally, grievances from two residents documented ongoing issues with meal trays, specifically that dining staff were not referencing meal tickets and were omitting food items. Interviews with facility leadership confirmed that staff are expected to review meal tickets to ensure residents receive appropriate items and avoid serving restricted foods. The facility's policy requires menus to be followed and to accommodate resident preferences, but observations and records indicated this was not consistently practiced.