F0809

E

Failure to Provide Substantial Bedtime Snacks When Meal Intervals Exceeded 14 Hours

Saint Louis, Missouri Survey Completed on 11-17-2025

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that meals and snacks were provided in a manner that limited the interval between the evening meal and breakfast to 14 hours or less and to provide a substantial bedtime snack when that interval exceeded 14 hours. The facility’s written Meals and Snacks policy required meals to be provided on a regularly scheduled basis and specified that mealtimes be scheduled to ensure a maximum of 14 hours from dinner to breakfast, but the policy did not address the requirement for a substantial bedtime snack when more than 14 hours elapsed between meals. The posted mealtime schedule for several halls showed breakfast from 8:00 A.M. to 9:30 A.M., lunch from 12:00 P.M. to 1:30 P.M., and dinner from 5:00 P.M. to 6:30 P.M., resulting in up to 15 hours between dinner and breakfast. Observations on multiple days confirmed that meals were served during these timeframes, including dinner service as late as 6:30 P.M. and breakfast trays still leaving the kitchen as late as 9:22 A.M.

Resident council minutes documented repeated complaints that snacks were not being given out, that residents were not receiving what they ordered, and that beverages were missing from trays. Residents reported that bedtime snacks were left at the nurse’s station and that staff did not routinely pass them unless residents specifically asked, with one resident stating they did not know snacks were available. An activity aide reported that residents frequently complained that breakfast was served late and that they were not receiving evening snacks, and that snacks were not being offered or provided when requested. Interviews with cognitively intact residents revealed that they typically did not receive evening or bedtime snacks, that available snacks were limited to cookies, chips, or snack cakes, and that they were not informed they could receive more substantial items such as sandwiches.

Several residents described long intervals without food and difficulty obtaining substantial snacks at night. One resident stated dinner was usually served around 5:00 P.M. but sometimes later, and that they had not been offered snacks in the evening for months except on one recent occasion; they had never been offered a sandwich and would be interested in one, especially when dinner was early or intake was low. Another resident reported that breakfast sometimes arrived as late as 9:30 or 10:00 A.M., that no snacks were offered at night, and that when they requested a sandwich at bedtime, staff refused, stating the resident had already eaten dinner. A different resident reported sometimes going up to 16 hours without food and only being offered insubstantial snacks like chips. Another resident stated that staff sometimes received snacks from the kitchen but did not always pass them out, and that snacks consisted of cookies and snack cakes, not substantial or healthy items; when this resident requested a sandwich at night, staff responded that no sandwiches had been sent and that they were “lucky” to get snacks at all. The dietary manager reported that sandwiches were placed in a resident refrigerator on the first floor, but observation of that refrigerator showed it was largely filled with personal items and contained no sandwiches. The dietitian stated that if more than 14 hours elapsed between dinner and breakfast, a substantial bedtime snack such as a sandwich, fruit cup, yogurt, and cookies would be expected, but also reported being told by the dietary manager that there were not more than 14 hours between meals and that residents were provided mainly snack items like peanut butter bars and chips, without mention of sandwiches.