Failure to Provide Therapeutic Diets as Ordered
Penalty
Summary
The facility failed to ensure that therapeutic diets were provided as ordered by physicians for four residents reviewed. Residents with specific dietary needs, such as those on renal diets or requiring gluten and lactose-free diets, were observed receiving foods and beverages that were not in accordance with their prescribed diets. For example, residents with renal diet orders received foods such as milk, cheese, sausage, ham, and vegetable soup, all of which were listed as restricted items for renal diets according to the facility's own therapeutic diet definition sheet. Additionally, residents reported receiving high-sodium snacks and orange juice, which were also restricted. Staff interviews revealed a lack of knowledge regarding the specific dietary restrictions for residents on therapeutic diets. Certified Nursing Assistants (CNAs), Licensed Practical Nurses (LPNs), and dietary staff were unable to identify which foods were restricted for residents on renal diets or gluten and lactose-free diets. Meal tickets and dietary orders were not consistently followed, and staff confirmed that residents were regularly served foods that were not compliant with their dietary restrictions. One resident with gluten and lactose sensitivity reported abdominal pain after consuming a supplement containing milk protein and stated that she routinely received inappropriate foods, leading her to rely on food brought in by her family. Another resident with an order for a mechanically altered diet and thickened liquids due to dysphagia was observed using straws and consuming unthickened liquids, contrary to physician orders. Staff were unaware of the order prohibiting straws and had not been thickening the resident's liquids. Documentation showed that the resident had been non-compliant with the diet order, but staff had not consistently documented refusals or set up care conferences as required by facility policy. Facility policies required meals to be checked against therapeutic diet spreadsheets and meal tickets, but these procedures were not followed, resulting in residents not receiving diets as ordered.