Failure to Provide Substantial Snacks and Meal Alternatives Outside Scheduled Meal Times
Penalty
Summary
The facility failed to provide substantial snacks or meal alternatives for residents who required food outside of scheduled meal times, particularly when there was more than 14 hours between the evening meal and breakfast. Record reviews and interviews revealed that a resident with complex medical conditions, including end stage renal disease, diabetes, and chronic heart failure, often returned from dialysis appointments late in the evening and did not consistently receive dinner or substantial snacks. Documentation of meal intake was inconsistent, and staff sometimes marked the resident as 'not available' for dinner, even though the resident returned later and required food. Observations and staff interviews confirmed that kitchenettes on the units were not consistently stocked with substantial snacks or meal alternatives, such as sandwiches or salads, after the kitchen closed in the evening. The kitchen manager and nursing staff acknowledged that after the kitchen closed, only limited snack items like pudding, crackers, and chips were available, which did not constitute a meal. There was also confusion among staff regarding their ability to access the kitchen after hours to provide food for residents, and the process for restocking snacks was not reliably followed. Additional interviews with cognitively intact residents indicated that snacks were only available if the kitchenettes happened to be stocked, which was not always the case. Observations confirmed that essential snack items and meal alternatives were missing from the units, and the kitchen manager stated that the kitchen was responsible for stocking these items but did not keep track of inventory. As a result, residents who needed food outside of traditional meal times, especially those returning late from medical appointments, did not have access to suitable and nourishing alternatives.