Failure to Follow Menu and Provide Documented Substitutions When Milk Was Unavailable
Penalty
Summary
The deficiency involves the facility’s failure to follow the written menu and to provide and document nutritionally equivalent substitutions when milk, a planned menu item, was unavailable. A cognitively intact resident with cirrhosis of the liver with ascites, hepatitis, hypertension, and hyponatremia reported that the facility did not have milk for two days and that milk was only obtained later from a local supermarket, initially only 2% milk. Multiple CNAs confirmed that on two consecutive days on day shift, and one of those days on PM shift, milk was not available to be served to residents. Observations on a later date showed that residents requested milk with their meals per their preferences. The facility’s own policy states that menus are to be followed as written and that when an item cannot be procured, the Dietary Manager or Registered Dietitian (RD) must document substitutions, with the RD approving them on a substitution form. The RD stated that she was not aware of any milk shortage, had not made any substitutions, and indicated that if she had known, she would have ordered yogurt or cottage cheese as substitutes for milk to ensure proper calcium intake. The Dietary Manager reported that a milk order had been placed but that the delivery did not arrive because the bill was not processed on time, and that the facility did not have milk on two specific days until milk arrived later in the afternoon on the second day; someone went out to purchase milk for that second day. Review of the food substitution log for January showed no documented substitutions for the missing milk on those two days, despite milk being a planned item at breakfast and dinner. The Administrator acknowledged authorizing the purchase of milk at a local supermarket and could not explain why residents did not receive milk for two days. The Administrator also stated there was no policy on menu changes or substitutions available, and the Dietary Manager, who had only been at the facility for a month, was unable to provide or explain facility policies related to menu changes and ordering supplies when items are not received.
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