Failure to Follow Planned Menus and Approved Substitutions for Therapeutic and Texture-Modified Diets
Penalty
Summary
The facility failed to follow the planned menu for residents on renal, diabetic renal, mechanically altered, and pureed diets during a lunch meal. Specifically, the planned menu indicated that residents on renal and diabetic renal diets were to receive carrots, but due to a delayed shipment, carrots were not available at the time of meal service. Instead, sliced cucumbers were served, although this substitution was not communicated or approved according to the facility's procedures. The Certified Dietary Manager (CDM) and Assistant Dietary Manager both confirmed that the menu was not followed and that there was confusion regarding appropriate substitutions, with the Registered Dietitian (RD) not being informed about the need for a substitution for carrots. Additionally, for residents on mechanically altered and pureed diets, the planned menu called for baked chicken leg (ground or pureed with gravy), but hamburger meat was prepared and served instead. The dietary staff responsible for meal preparation stated that they followed the menu and consistency sheets, but the Assistant Dietary Manager and CDM were unaware of why hamburger meat was used in place of chicken. The RD was also not informed that hamburger meat was served instead of the planned menu item. These failures affected 7 residents on renal diets, 3 residents on diabetic renal diets, 17 residents on mechanically altered diets, and 12 residents on pureed diets. The deficiencies were identified through tray line observation, record review, and staff interviews, which revealed a lack of communication, failure to follow the planned menu, and improper handling of menu substitutions for therapeutic and texture-modified diets.