Failure to Provide Alternate Meal Options and Post Menus
Penalty
Summary
The facility failed to provide alternate meal options of equal nutritional value to residents who declined the main meal, as required by their own policy and regulatory standards. Record reviews, observations, and interviews revealed that three residents out of a sample of eighteen were not regularly offered alternate meals when they did not want the meal originally served. For example, one resident with a moderately impaired cognitive status and on a No Added Salt (NAS) diet was not offered an alternate vegetable when she declined carrots, and she confirmed that no other vegetable options were available. The posted menus only listed alternates for the main entrée, with no alternates for vegetables or starches, and the Always Available Menu was not posted in accessible areas as expected. Observations during meal service confirmed that residents were only offered the main entrée or a single alternate, which was often the same for both lunch and dinner, and no alternate vegetables or starches were provided. The Food Services Manager acknowledged that only one alternate entrée was available per meal and that the Always Available Menu was not posted as required. Residents on special diets were also not provided with alternate meal options. The Registered Dietician stated that her expectation was for alternates of equal nutritive value to be available for each meal and for menus to be posted where residents could access them. Resident interviews further supported these findings, with residents reporting that the alternative menu had been removed about a month prior and that staff did not offer alternatives if residents wanted something other than the main meal. The facility's own policy required that alternatives be immediately available if the primary menu was not to a resident's liking, but this was not being followed. These actions and inactions led to a deficiency in providing resident choice and adequate nutrition as required.